Craig Anne Heflinger

The Caregiver Strain Questionnaire Measuring the Impact on the Family of Living with a Child with Serious Emotional Disturbance

The impact on the family of having a family member with serious emotional problems has been an area of concern as deinstitutionalitation and managed care have shifted treatment to the community and primary caregiving to the family. Measures are needed to assess caregiver strain in a way that can lead to a better understanding of the phenomena, improve clinical interventions, and examine the outcomes of new treatment modalities on the clients family. In order to study the effects of this treatment shift, the Caregiver Strain Questionnaire (formerly the Burden of Care Questionnaire) was developed for use with families of children and adolescents with emotional and behavioral disorders. Findings from exploratory and confirmatory factor analyses support the existence of three related but unique dimensions of strain experienced by parents of this population. This study adds to the current body of knowledge by suggesting that subjective caregiver strain has two components, and not the single form claimed in previous research. The results also indicate that the Caregiver Strain Questionnaire is a reliable and valid scale for the measurement of caregiver strain among families of children with emotional or behavioral disorders.

Evaluating managed mental health services: The Fort Bragg experiment.

Introduction. Methods. Description of the Evaluation Sample. Access and the Intake and Assessment Process. The Treatment Process and Service Utilization. Mental Health Outcomes. Cost Outcomes. Implications and Conclusions. Index.

Using the CBCL to determine the clinical status of children in state custody

Abstract This manuscript reviews information on past use of the CBCL to describe the clinical status of children in state custody and the results of a recent study of a representative statewide sample. The sample included a random sample of children in state custody, including those in foster care, kinship care, group residential facilities, and state institutions. One third (34%) of the children in state custody were reported as having significant behavior problems. The narrow band scales reflecting greatest difficulties included Aggressive, Delinquent, and Withdrawn behavior. The youngest teenage group was significantly more likely to have Internalizing problems in the clinical level, and those living in family homes were more likely to have scores in the non-clinical range than those in foster homes or group placements. There were no effects of gender, race, adjudication status, or length of time in custody. Implications for policy makers, caseworkers, and researchers are discussed.

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.

The stigma of childhood mental disorders: A conceptual framework

OBJECTIVE To describe the state of the literature on stigma associated with childrens mental disorders and highlight gaps in empirical work. METHOD We reviewed child mental illness stigma articles in (English only) peer-reviewed journals available through Medline and PsychInfo. We augmented these with adult-oriented stigma articles that focus on theory and measurement. A total of 145 articles in PsychInfo and 77 articles in MEDLINE met search criteria. The review process involved identifying and appraising literature convergence on the definition of critical dimensions of stigma, antecedents, and outcomes reported in empirical studies. RESULTS We found concurrence on three dimensions of stigma (negative stereotypes, devaluation, and discrimination), two contexts of stigma (self, general public), and two targets of stigma (self/individual, family). Theory and empirics on institutional and self-stigma in child populations were sparse. Literature reports few theoretic frameworks and conceptualizations of child mental illness stigma. One model of help seeking (the FINIS) explicitly acknowledges the role of stigma in childrens access and use of mental health services. CONCLUSIONS Compared with adults, children are subject to unique stigmatizing contexts that have not been adequately studied. The field needs conceptual frameworks that get closer to stigma experiences that are causally linked to how parents/caregivers cope with childrens emotional and behavioral problems, such as seeking professional help. To further research in child mental illness, we suggest an approach to adapting current theoretical frameworks and operationalizing stigma, highlighting three dimensions of stigma, three contexts of stigma (including institutions), and three targets of stigma (self/child, family, and services).

Risk factors for serious alcohol and drug use: the role of psychosocial variables in predicting the frequency of substance use among adolescents

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 adolescents choice of peers and their own attitudes toward delinquency and drug use.

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.

Stigma in Child and Adolescent Mental Health Services Research: Understanding Professional and Institutional Stigmatization of Youth with Mental Health Problems and their Families

To understand the low utilization rates of child and adolescent mental health services, it is necessary to recognize the kinds of professional and institutional stigma that may produce barriers to care. We address the large literature on the stigmatization of mental illness, linkages between such literature and children’s mental health services use, and the kinds of professional and institutional attitudes and practices that communicate shame and low expectations to youth and their families. It will take recognition of such stigmatizing practices—including overcoming resistance to the messages presented herein—to make real progress in the effort to increase utilization of evidence-based practices. Multi-faceted, multi-level, and multi-disciplinary approaches to both research and intervention are recommended.

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.