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The breadth of doctoral education has expanded to include professional development activities in order to prepare students for academic and nonacademic careers. This mixed methods study focused on students' perceptions of professional development opportunities at a Research One university. The findings suggest that most students feel prepared in scholarly-related activities; but they identify gaps in areas such as preparation for grant writing, teaching, and leading research teams. Statistically significant differences in perceived preparation were noted among disciplines. We offer suggestions for future research in doctoral professional development and recognize the need to expand and diversify centralized, institution-based resources so as to pave the pathway to successful careers for graduate students.

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.)

Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n = 163) with qualitative interviews (subsample n = 21). Most of the mothers expressed confidence in mental health care providers' to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents' mental health problems, and building community resources to enable all youth to participate in community life.

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.)

Context: All youth, especially those with serious emotional disturbances (SED), face challenges as they transition to adulthood. Little is known about rural youth at risk for transition problems. Purpose: To examine transition-age youth who use publicly funded services in rural and urban/suburban locations in Tennessee in order to describe youth at risk for transition difficulties who need policy and service planning. Methods: Using Medicaid enrollment and claims/encounter data, youth at high risk for transition difficulties were identified in the following groups: SED, at risk of or in foster care/state custody, intensive or frequent mental health services users, or diagnosed with major mental disorders, behavior disorders, mental retardation, or substance use. Membership in these groups was compared between youth living in rural and urban/suburban counties. Multivariate regression was used to examine factors related to multiple group membership. Findings: Rural youth were more likely to be in groups at high risk for problems transitioning to adulthood, and enrolled in Medicaid as uninsured/uninsurable, compared to their urban counterparts. The strongest factors associated with multiple risk group membership were being in state custody/foster care and receiving Supplemental Security Income (SSI). Conclusions: Services are needed to support the transition to adulthood for youth at high risk of behavioral and adjustment problems. Systems to support coordinated planning and accountability are needed, including data on populations and services, and research on transition-age youth.

Many youths in juvenile justice are in need of substance use services, yet referral to services is often inadequate. This study examines the ecological factors related to substance use service referrals made through Tennessee's juvenile courts. A series of hierarchical binomial logistic models indicated that individual-level factors accounted for 31% of the variance among courts in referral rates. Community and court factors accounted for an additional 16% of the variance. Youths were more likely to be referred if they had a higher need, were white, were male, were adjudicated in communities that had a higher service density, and appeared in courts that had good relationships and frequent contact with mental health providers. Controlling for individual need, youths in rural areas tended to have lower referral rates; however, this relationship was mediated by the frequency of contact and the quality of relations between the court and mental health providers and county average socioeconomic status. (Contains 3 tables.)

Clinicians emphasize the importance of motivation to change for effecting recovery from substance abuse disorders. However, little is known about motivation to change substance-abusing behavior among adolescents or its impact on treatment outcomes. The present research examines motivation to change among youth admitted to publicly funded substance abuse services and its influence on treatment outcomes. Data are based on interviews with 129 youth between 12 and 18 years of age. Multilevel (HLM) analyses are used to assess the relationship between substance use and motivation to change at the time of treatment admission and roughly one year later. Results suggest that more serious substance users are motivated better to change at the outset of treatment and experience more rapid declines in substance use after treatment begins.

While psychology has tended to focus on urban issues in research and practice, rural areas have undergone a series of changes in recent years that have increased the need for behavioral health services. A variety of social and economic factors has contributed both to the increasing needs and to the inability of the existing services to meet them. In this article, the authors survey the literature on rural behavioral health issues, focusing on children and adolescents, to highlight the status of knowledge and approaches to intervention. A conceptual rubric based on the social ecological perspective is used. First, what is known about rural behavioral health and health care for youth is described at the ontogenetic, micro-, meso-, and macrosystem levels. Strategies that have been proposed to address problems in rural behavioral health care are also presented at the different levels. General principles for future intervention and research are proposed that recognize the unique context of rural communities, use local knowledge and ideas, incorporate the efforts of informal systems of care using a strength-based approach, and identify and work toward solving the macrosystem issues that underlie rural health problems.

The past decade has shown a surge of interest in faith-based resources for a variety of social problems. However, these resources have not been systematically studied for children with emotional and behavioral problems. We investigated religious activity and use of pastoral counseling among Protestant youth with serious emotional disorders (SED) (N=464) and examined associated youth and caregiver characteristics. Findings indicate that the majority of SED youth do participate in religious activities, but do not frequently receive pastoral counseling for their problems. Youth with fewer externalizing problems as well as minority youth had an increased likelihood of participation in religious activities, while youth with more psychosocial impairment had an increased likelihood of using pastoral counseling. Implications of this study for research and practice are discussed.

This study examined caregiver strain (i.e., burden of care, caregiver burden) among families of adolescents in treatment for substance abuse disorders compared to youth with mental health problems. We used descriptive and regression analyses to compare groups and to examine the youth and family variables associated with caregiver strain across the two samples. The caregivers of the two groups of youth reported similar levels and types of caregiver strain at the subscale and item levels. In addition, there were similar patterns among the variables that predicted two of three dimensions of caregiver strain. We conclude that attending to caregiver strain in both substance abuse treatment and research is indicated.

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.

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.

Although Medicaid is the largest public payer of behavioral health services, information on access and utilization of services is lacking, and no data on the frequency of service use or types of services provided for children with autism spectrum disorders (ASDs) are available. As states move toward managed care approaches for their Medicaid program, services information is critical. Behavioral health service data for children with autism spectrum disorders were collected from a state Medicaid Managed Care (MMC) program and analyzed from fiscal years 1995 through 2000. Findings revealed that the number of children who received services over time increased significantly; however, the rate of service use was only one tenth of what should be expected based on prevalence rates. The mean number of service days provided per child decreased significantly, about 40%, and the most prevalent forms of treatment changed. Day treatment vanished and medication and case management increased disproportionately to the number of children served. Explanations and implications of the findings are presented as well as recommendations for future research.

With the prevalence of kinship care increasing, it is critical to understand the role of caregiver strain among this population. This study focused on the strain experienced by relative caregivers as compared to parents who were caring for children with serious emotional disturbance (SED). Descriptive and multiple regression analyses demonstrated that both caregiver groups reported similar amounts of elevated strain, with the exception that parent caregivers of children with SED reported more subjective internalized strain than did other relative caregivers. The child welfare system, providers of behavioral health services, and policy-makers need to pay closer attention to this special population of caregivers and the children in their care. (Contains 4 tables.)

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)

This study demonstrates the usefulness of cluster analytic patterns of care in a sample of 979 children receiving federal mental health services. Six patterns were identified. These service-utilization clusters provide a useful and easily understood way to summarize children's quantity of use of various mental health services. (SLD)

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)

Reviews of the psychosocial risk factors of adolescent alcohol and drug use suggest that the highest risks can be summarized as: 1) psychological functioning, 2) family environment, 3) peer relationships, and 4) stressful life events. The purpose of this study is to describe the relationships among the most common risk factors among a clinical sample (n = 214) and to determine the collective importance of these risk factors on problems with substance use. Collectively, these risk factors were most effective in explaining alcohol use and binge drinking and marijuana use, which were the most frequent types of substance use in this sample. Antisocial peers and delinquent behavior were the strongest predictors of substance use. Implications are that treatment programs target different psychosocial factors depending on the substance being used, and put extra effort on understanding and altering the relationship between an adolescent's choice of peers and their own attitudes toward delinquency and drug use. Keywords: Adolescents, risk factors, substance use, INTRODUCTION Drug and alcohol use among adolescents continues to be a public health problem. The National Household Survey of Drug Abuse (1) found that more than 10% of 12-17 year [...]