Ana María Brannan

The Role of Caregiver Strain and Other Family Variables in Determining Children's Use of Mental Health Services.

This study used a prominent model of family stress and coping to examine whether caregiver and family variables predicted child mental health service utilization patterns, holding constant the child clinical and demographic variables.We were especially interested in the impact of caregiver strain on childrens use of mental health services. We found caregiver strain to be associated with the combination of services used, sequencing of services, gaps in care, and cost of services. Other family variables that predicted childrens service use included material resources, life events, and family functioning. Child clinical variables improved the explanatory power of the models considerably. When all other variables were included in the model, childs age was the only demographic variable that predicted service use patterns.

Distinguishing Caregiver Strain from Psychological Distress: Modeling the Relationships Among Child, Family, and Caregiver Variables

Although both have been used in studies of the impact of mental illness on the family, the constructs of caregiver strain (often referred to as “burden of care”) and psychological distress have not been clearly distinguished. The vagueness surrounding these constructs, and the lack of a cohesive conceptual framework for understanding how they relate, leads to contradictory interpretations of results. This compromises the building of the knowledge base needed to develop and evaluate interventions to support families as they struggle to meet the needs of their children with emotional and behavioral challenges. We utilized the ABCX Model as a framework for understanding caregiver strain and its relationship to psychological distress. Structural equations modeling was used to test the hypothesized relationship between caregiver strain and psychological distress, as well as the role of key child and family variables. These included child symptoms, stressful life events, social support, family functioning, and material resources. Our findings indicated that caregiver strain and psychological distress, although related, have distinct correlates and different implications in the family context.

Measuring satisfaction with children's mental health services: Validity and reliability of the satisfaction scales

This paper describes the measurement of parent and adolescent satisfaction with childrens mental health services delivered in a case managed continuum of care model. Internal consistency of the scales was assessed. Correlational analyses were conducted to explore the extent to which the Satisfaction Scales replicated findings by other research in the literature. Based on these analyses, the Satisfaction Scales were demonstrated to be reliable instruments to measure parent and adolescent satisfaction with child and adolescent mental health services. Validity was assessed using confirmatory factor analysis to determine whether the content areas truly represented distinct, although related, dimensions of satisfaction. Preliminary exploration of the validity of the parent version of the Satisfaction Scales for outpatient services supported the existence of four dimensions of satisfaction including: (1) access and convenience, (2) childs treatment process and relationship with the therapist, (3) parent and family services, (4) global satisfaction.

Caregiver, Child, Family, and Service System Contributors to Caregiver Strain in Two Child Mental Health Service Systems

Childrens 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.

Participation in the Paid Labor Force by Caregivers of Children With Emotional and Behavioral Disorders

We explored the relationship between school-age childrens emotional and behavioral symptoms and workforce participation of their family caregivers using structural equation modeling. Secondary analysis of data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program was performed with a subsample of 2,585 caregivers. Findings from structural equation modeling indicated that higher levels of internalizing and externalizing symptoms were significant predictors of more frequent school absences, less adequate childcare, and greater caregiver strain related to missing work. In turn, more adequate childcare and greater caregiver strain from missed work were associated with lower likelihood of workforce participation. Further research on labor force participation and increased family support is necessary to improve work—life integration for caregivers of children with emotional and behavioral disorders. Future investigations should examine caregiver employment as a standard family outcome.

Parent satisfaction with children’s mental health services in a children’s mental health managed care demonstration

This article presents findings from a quasi-experiment that included the use of satisfaction scales to compare parent’s satisfaction with the services their children received through two different mental health care delivery systems. Satisfaction with the following three types of service were compared: (1) intake assessment during the admission process to any service setting, (2) outpatient services, and (3) residential treatment including inpatient hospitalization and residential treatment centers (RTCs). Additionally, satisfaction with several areas of care (e.g., access, treatment process, therapist relationship, parent and family services, discharge and transition planning), as well as global satisfaction, was assessed. In general, parents whose children received services through an innovative continuum of care system reported significantly higher satisfaction with intake assessment and outpatient services than did parents whose children received care in a traditional fee-for-service system. Fewer differences were found in satisfaction with residential services.

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.

Common Patterns of Service Use in Children's Mental Health.

Evaluators and program administrators need simple multivariate descriptions of mental health service utilization. This study demonstrates the utility of cluster analytic patterns of care in a sample of 979 children receiving formal mental health services. Six patterns were identified: (a) brief outpatient; (b) extended outpatient; (c) hospital with outpatient; (d) non-residential more-than-outpatient; (e) extended residential; and (f) atypical heavy-service outliers. Children in high-cost clusters had above-average clinical severity. Children in a continuum of care used three patterns (b, d and e) more often, while those served through a traditional fee-for-service system used two clusters (a and c) more often. Service utilization clusters provide a useful and easily-understood vocabulary for summarizing childrens quantity of use of various mental health services.

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.

Differences in the Experience of Caregiver Strain Between Families Caring for Youth with Substance Use Disorders and Families of Youth with Mental Health Problems

ABSTRACT 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.