Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Objective: Research in a variety of human service fields has linked positive child outcomes with caregiver involvement. However, research on caregiver involvement in children's mental health services is limited and most is focused primarily on service use and is cross sectional in design. The purpose of this study was to examine caregiver experiences of involvement in planning services for children with serious emotional disturbance (SED) and its influence on child and caregiver outcomes over time. A secondary analysis was performed on five waves of Comprehensive Community Mental Health Services for Children and Families program evaluation data (N=104). Methods: Generalized Estimating Equations (GEE) regression methods were used to test the relationship between caregiver involvement and child emotional and behavioral problems and strengths as well as caregiver strain, empowerment, and satisfaction, while controlling for sociodemographic differences and previous levels of functioning. GEE is an extension of generalized linear modeling developed for fitting models involving repeated measurements of the same subject or cluster (Zeger & Liang, 1986). GEE is robust, controls for within-subject autocorrelation of repeated measures, and provides consistent, asymptotically unbiased parameter and variance estimates with fewer distributional assumptions that restrict the use of classical approaches to multivariate analysis. Additionally, GEE pools the responses of each respondent across waves, thereby effectively increasing sample size and boosting power. Results: Caregivers reported high ratings of involvement (M = 3.33, range 1 – 4). Caregiver involvement was positively related to caregiver empowerment (z = 2.22, p < .05) and satisfaction with involvement (z = 4.40, p < .001). The influence of involvement on child outcomes was mediated by caregiver outcomes. The more satisfied caregivers felt as a result of their involvement, the fewer behavioral problems (z = -3.94, p < .001) and the more behavioral strengths (z = 2.31, p < .05) perceived in their children. Conclusions: These findings have important implications for policy, practice, and research. The proximal and distal benefits of caregiver involvement in planning services provide support for policies mandating inclusion of caregivers in planning, implementing, and evaluating children's mental health services. These benefits include use of caregiver involvement as an intervention strategy by which practitioners can effect change in child outcomes. However, more conceptual and empirical work is needed to identify the specific mechanisms by which caregiver involvement influences child outcomes.