Role of Caregiver Strain in Child Relinquishment: Supporting Caregivers of Children with Serious Emotional Disturbances (SEDs)

Background. Roughly 5% of children are classified as having a serious emotional disturbance (SED). Although exact numbers are not known, anecdotal evidence suggests that some families seek and/or are advised to relinquish the custody and care of their children to the foster care system or juvenile justice systems.  Caregivers raising children with SED face additional day-to-day demands in parenting.  Caregiver strain, or the extent to which caregivers experience stress as a result of caring for children with SEDs, can be experienced both objectively and subjectively.  This study seeks to explore the relationship between objective caregiver strain (financial strain, missed work, disrupted time, and disrupted family relationships) and subjective internalizing strain (worry, feeling sad, feeling tired) on child relinquishment.   

Methods. As part of a statewide needs assessment of children with SED, an online survey was administered to 28 caregivers of children with SEDs.  A convenience sample of caregivers was recruited through state agencies, advocates and parent groups.  The Caregiver Strain Questionnaire- SF7 was used to assess objective and subjective internalizing strain. Caregivers were also asked to identify if they had considered relinquishing parental rights or had relinquished their rights in order to obtain mental health services for their children.  Additionally, five case studies were conducted with caregivers of children with SEDs using a semi-structured interview guide.

Results. Approximately 1/3 of caregivers indicated they had considered relinquishment, relinquished, or had a child placed in the juvenile justice system solely to obtain mental health care.  There was a statistically significant correlation between objective caregiver strain (.545) and subjective internalizing strain (.740) and the consideration of relinquishment, relinquishment, or placing a child in the juvenile justice system because there were no other options.  In the five case studies, all parents interviewed discussed the significant toll that addressing their child’s serious emotional disturbance had taken on the entire family, both physically and emotionally.   All families felt that they had been judged, stigmatized and left out of services provided to their child with SED.  They indicated a need for a more holistic approach to working with families, not just children.

Implications. The impact of caring for a child with a SED has a significant impact on the entire family, including parents and siblings.  Findings from this study support a family-centered approach to care that addresses caregiver strain directly.  It is important that professionals in social work, mental health, medical and education fields develop practices to help families without placing shame and stigma on the parents.  Due to the small sample size, further exploration is advised to determine the nature of the relationship between caregiver strain and relinquishment.