Caregiver Involvement in Planning Services: Outcomes For Children With SED

Caregiver involvement in children's mental health services is social work value, a policy mandate, and a growing trend in the human services (NASW, 1999; USDHHS, 2003, Friesen & Stephens, 1998). Research in a variety of human service fields has linked positive child outcomes with caregiver involvement (Davis et al., 1996; Grolnick & Slowiaczek, 1994; Jones, 1994). However, research on caregiver involvement in children's mental health services is limited and focused primarily on service use and cross sectional methods. Significant direct effects of involvement on child outcomes have not been found. Previous research suggests a mutual influence of caregiver and child functioning (Resendez et al., 2000; Early et al., 2002), including positive associations between caregiver empowerment and satisfaction with involvement and child functioning (Taub et al., 2001; Noser & Bickman, 2000). This study advances previous research by examining the effects involvement in planning services on outcomes for children with serious emotional disturbance (SED) and their caregivers over time.

A secondary analysis was performed on five waves of data from the Comprehensive Community Mental Health Services for Children and Families program evaluation. Caregiver were interviewed at six-month intervals regarding child emotional and behavioral problems and strengths, involvement in decision-making, and empowerment and satisfaction with involvement. Multivariate analyses were conducted using generalized estimating equations (GEE), an extension of generalized linear modeling developed for fitting models involving repeated measurements of the same subject or cluster. GEE regression methods are used to test the relationship between caregiver involvement and child emotional and behavioral problems and strengths as well as empowerment and satisfaction, while controlling for sociodemographic differences and previous levels of functioning.

Most respondents (N=104) were female (87.5%) with an average age of 46.6 years. The median income range was $20,000 to $24,999 and 93% of respondents had at least a high school education. Most children described by caregivers were white (88.5%) males (73.1%) with an average age of 14.4 years (SD=2.9) and multiple presenting problems (M=7.7, SD=5.2, range 1-23). Child and caregiver outcomes were significantly bivariately related. Multivariate analysis revealed no significant direct effects of involvement on child outcomes. However, caregiver involvement was found to be directly related to caregiver empowerment (z=2.26, p<.05) and satisfaction with involvement (z= 3.35, p<.01) and indirectly related to child emotional and behavioral problems (z =2.09, p < .05) and strengths (z =2.26, p<.05).

The findings have important implications for social work policy, practice, and research. The more empowered and satisfied caregivers were as a result of their involvement, the greater the perceived functional improvement in their children. More conceptual and empirical work is needed to identify the mechanisms by which the influence of caregiver involvement extends beyond their own outcomes to those of the child. However, the findings support the current polices and practices of involving caregivers in their child's mental health care.