Abstract
This study provides a description of caregiver strain in a sample of caregivers of students with emotional and behavioral disorders receiving school-based services. Few studies have examined caregiver strain in school-based samples. Given poor outcomes for these youth, as well as the potentially influential role of caregiver strain in service use and engagement, understanding the caregiving experience in this population is important. The current study sought to: (1) examine the levels of the different types of caregiver strain reported by caregivers in the sample; (2) describe the level of the different types of caregiver strain reported by different groups of participants; and (3) examine the relationship between caregiver strain and various student and caregiver characteristics. This study is a secondary analysis of data collected from 243 students and their caregivers enrolled in one of two larger studies examining the effectiveness of a parent support intervention. Overall, results suggest that caregivers of students with emotional and behavioral disorders may experience strain as a result of their child’s problems that goes beyond usual daily life stressors. Internalized strain directed inward toward caregivers themselves appears to be of particular importance in this population. Conclusions and recommendations for future research are discussed.
Similar content being viewed by others
References
Angold, A., Messer, S. C., Stangl, D., Farmer, E. M. Z., Costello, E. J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88(1), 75–80. doi:10.2105/Ajph.88.1.75.
Brannan, A. M. (2003). Ensuring effective mental health treatment in real-world settings and the critical role of families. Journal of Child and Family Studies, 12(1), 1–10.
Brannan, A. M., Athay, M. M., & de Andrade, A. R. V. (2012). Measurement quality of the caregiver strain questionnaire-short Form 7 (CGSQ-SF7). Administration and Policy in Mental Health and Mental Health Services Research, 39(1–2), 51–59. doi:10.1007/s10488-012-0412-1.
Brannan, A. M., & Heflinger, C. A. (2001). Distinguishing caregiver strain from psychological distress: Modeling relationships among child, family, and caregiver variables. Child and Family Studies, 10(4), 405–418. doi:10.1023/A:1016705306848.
Brannan, A. M., Heflinger, C. A., & Foster, E. M. (2003). The role of caregiver strain and other family variables in determining children’s use of mental health services. Journal of Emotional and Behavioral Disorders, 11(2), 77–91. doi:10.1177/106342660301100202.
Brannan, A. M., & Heflinger, C. A. (2006). Caregiver, child, family, and service system contributors to caregiver strain in two child mental health service systems. Journal of Behavioral Health Services & Research, 33(4), 408–422. doi:10.1007/s11414-006-9035-1.
Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The caregiver strain questionnaire: Measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5(4), 212–222.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., et al. (1995). Children’s mental health service use across service sectors. Health Affairs, 14(3), 147–159.
Bussing, R., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., & Garvan, C. W. (2003a). Child temperament, ADHD, and caregiver strain: Exploring relationships in an epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 42(2), 184–192.
Bussing, R., Zima, B. T., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., & Garvan, C. W. (2003b). Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), 842–850. doi:10.1097/01.Chi.0000046876.27264.Bf.
Chavira, D. A., Garland, A., Yeh, M., McCabe, K., & Hough, R. L. (2009). Child anxiety disorders in public systems of care: Comorbidity and service utilization. Journal of Behavioral Health Services and Research, 36(4), 492–504.
Cook, J. R., & Kilmer, R. P. (2010). The importance of context in fostering responsive community systems: Supports for families in systems of care. American Journal of Orthopsychiatry, 80(1), 115–123.
Duchnowski, A. J., Kutash, K., Green, A. L., Ferron, J. M., Wagner, M., & Vengrofski, B. (2012). Parent support services for families of children with emotional disturbances served in elementary school special education settings: Examination of data from the Special Education Elementary Longitudinal Study. Journal of Disability Policy Studies, 24(1), 36–52.
Evans, S. W., Sibley, M., & Serpell, Z. N. (2009). Changes in caregiver strain over time in young adolescents with ADHD: The role of oppositional and delinquent behavior. Journal of Attention Disorders, 12, 516–524.
Farmer, E. M. Z., Burns, B. J., Angold, A., & Costello, E. J. (1997). Impact of children’s mental health problems on families: Relationships with service use. Journal of Emotional and Behavioral Disorders, 5(4), 230–238. doi:10.1177/106342669700500406.
Farmer, E. M., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66.
Friesen, B. J., & Huff, B. (1996). Family perspectives on systems of care. In B. A. Stroul (Ed.), Children’s mental health: Creating systems of care in a changing society (pp. 41–67). Baltimore: Paul H. Brookes.
Garland, A. F., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L., & Landsverk, J. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), 1336–1343.
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345. doi:10.1097/00004583-200111000-00015.
Heflinger, C. A., Northrup, D. A., Sonnichsen, S. E., & Brannan, A. M. (1998). Including a family focus in research on community-based services for children with serious emotional disturbance: Experiences from the Fort Bragg Evaluation Project. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with behavioral and emotional disorders and their families: Programs and evaluation best practices (pp. 261–293). Austin, TX: Pro-Ed.
Heflinger, C. A., & Taylor-Richardson, K. D. (2004). Caregiver strain in families of children with serious emotional disturbance: Does relationship to the child make a difference? Journal of Family Social Work, 8(1), 27–45.
Huberty, C. J., & Morris, J. D. (1989). Multivariate analysis versus multiple univariate analyses. Psychological Bulletin, 105(2), 302–308.
Jans, L., Stoddard, S., & Kraus, L. (2004). Chartbook on mental health and disability in the United States. An InfoUse Report.
Kang, E., Brannan, A. M., & Heflinger, C. (2005). Racial differences in responses to the Caregiver Strain Questionnaire. Journal of Child and Family Studies, 14(1), 43–56. doi:10.1007/s10826-005-1112-1.
Kutash, K., Duchnowski, A. J., & Green, A. L. (2015). Meeting the mental health needs of youth with emotional and behavioral disorders. Beyond Behavior, 24(2), 1–11.
Kutash, K., Duchnowski, A. J., Green, A. L., & Ferron, J. (2011). Supporting parents who have youth with emotional disturbances through a parent-to-parent support program: A proof of concept study using random assignment. Administration and Policy in Mental Health and Mental Health Services Research, 38(5), 412–427. doi:10.1007/s10488-010-0329-5.
Kutash, K., Duchnowski, A. J., Green, A. L., & Ferron, J. M. (2013). Effectiveness of the Parent Connectors program: Results from a randomized controlled trial. School Mental Health,. doi:10.1007/s12310-013-9106-4.
Kutash, K., Garraza, L. G., Ferron, J. M., Duchnowski, A. J., Walrath, & Green, A. L. (2012). The relationship between family education and support services and parent and child outcomes over time. Journal of Emotional and Behavioral Disorders, 21(4), 264–276. doi:10.1177/1063426612451329.
Mayberry, L. S., & Heflinger, C. A. (2013). How caregivers make meaning of child mental health problems: Toward understanding caregiver strain and help seeking. Families in Society-the Journal of Contemporary Human Services, 94(2), 105–113. doi:10.1606/1044-3894.4286.
McCabe, K. M., Yeh, M., Lau, A., Garland, A., & Hough, R. (2003). Racial/ethnic differences in caregiver strain and perceived social support among parents of youth with emotional and behavioral problems. Mental Health Services Research, 5(3), 137–147.
McDaniel, H. L., Schiele, B. E., Taylor, L. K., Haak, J., & Weist, M. D. (2014). Strengthening components and processes of family involvement in school mental health. In M.D. Weist, N.A. Lever, C.P. Bradshaw, & J.S. Owens (Eds.), Handbook of school mental health: Research, training, practice, and policy, second edition (pp. 195–208). New York: Springer.
Mellor, D. (2004). Furthering the use of the strengths and difficulties questionnaire: Reliability with younger child respondents. Psychological Assessment, 16(4), 396–401. doi:10.1037/1040-3590.16.4.396.
Meltzer, H., Ford, T., Goodman, R., & Vostanis, P. (2011). The burden of caring for children with emotional or conduct disorders. International Journal of Family Medicine, 2011, 1–8.
Rockhill, C., Violette, H., Vander Stoep, A., Grover, S., & Myers, K. (2013). Caregivers’ distress: Youth with attention-deficit/hyperactivity disorder and comorbid disorders assessed via telemental health. Journal of Child and Adolescent Psychopharmacology, 23(6), 379–385.
Shin, S. H., & Brown, T. A. (2009). Racial and ethnic disparities in caregiver strain and the use of child mental health services: A structural equation model. Psychiatric Services, 60(8), 1039–1045.
Spencer, S. A., Blau, G. M., & Mallery, C. J. (2010). Family-driven care in America: More than a good idea. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 19(3), 176–181.
Taylor-Richardson, K. D., Heflinger, C. A., & Brown, T. N. (2006). Experience of strain among types of caregivers responsible for children with serious emotional and behavioral disorders. Journal of Emotional and Behavioral Disorders, 14(3), 157–168. doi:10.1177/10634266060140030301.
U.S. Department of Education. (2014). 36th annual report to congress on the implementation of the individuals with disabilities education act, 2014. Office of Special Education and Rehabilitative Services, U.S. Department of Education. http://www.ed.gov/about/reports/annual/osep.
U.S. Department of Education. (2015). Digest of education statistics, 2013 (NCES 2015-011). National Center for Education Statistics. https://nces.ed.gov/fastfacts/display.asp?id=59.
Villagrana, M. (2010). Mental health services for children and youth in the child welfare system: A focus on caregivers as gatekeepers. Child Youth Services Review, 32(5), 691–697.
Wagner, M., Kutash, K., Duchnowski, A. J., Epstein, M. H., & Sumi, W. (2005). The children and youth we serve: A national picture of the characteristics of students with emotional disturbances receiving special education. Journal of Emotional and Behavioral Disorders, 13, 79–96.
Wagner, M., & Newman, L. (2012). Longitudinal transition outcomes of youth with emotional disturbances. Psychiatric Rehabilitation Journal, 35(3), 199–208.
Acknowledgments
This study was supported in part by the U.S. Office of Special Education Programs (Grant Number H324C040040) and the Institute of Education Sciences (Grant Number R324A090049).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Green, A.L., Kutash, K. & Duchnowski, A.J. Strain in Caregivers of Students with Emotional and Behavioral Disorders Receiving School-Based Services. School Mental Health 8, 441–451 (2016). https://doi.org/10.1007/s12310-016-9193-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12310-016-9193-0