€Œwe Wanted to Get Her Helpâ€�: Exploring Caregiver Perceptions of Decision-Making Roles during the Journey to Residential Treatment

Background and Purpose: The mental health care service system for youth can be difficult for caregivers to navigate. There is some evidence that child welfare involvement may help facilitate access to mental health care, particularly for foster youth. For some youth, mental and behavioral health needs escalate to the point where their safety, or the safety of their families and communities, is at risk. For these youth, residential treatment settings (RTS) provide a secure environment and access to specialized services. Despite increased research and policy interest in reducing the use of RTS, there have been few studies with caregivers who have tried to access these settings for youth. This study aimed to explore caregiver perceptions of the child welfare and mental health service systems during the process of accessing RTS placement for youth to inform efforts to better support caregivers of youth with significant behavioral health concerns.

Method: This study used primary data collection via semi-structured interviews to conduct an interpretive phenomenological analysis of caregivers of youth who have been placed in RTS. Nine interviews were completed with ten caregivers (sample included one couple). One caregiver discussed her experience with two separate youth, resulting in a total of 10 youth discussed across the nine interviews. Caregiver types represented in the study included private adoptive parents, biological parents, foster parents, and foster-to-adoption parents. This study utilized a multi-stage iterative analysis process to identify both descriptive and interpretive themes.

Results: The study identified three themes related to caregivers’ perception of their engagement with the child welfare system: Knowledge Source, Legal Partner, and Coercive Force. Interpretive themes related to how caregivers perceived their role in accessing mental health care for youth included Gaining a Voice and Losing Power as Services Intensified. Interpretive themes related to how caregivers perceived decision-making during the RTS placement process included that it was a Challenging Journey, and that the decision to seek RTS placement often came after an Inflection Point. Finally, the way that caregivers viewed their engagement with the child welfare system seemed to impact their experiences accessing mental health care, including RTS.

Conclusions and Implications: Findings portrayed a cycle in which caregivers gained a voice in decision-making through familiarity with mental health services that was lost when youth behavior escalated, and the service settings intensified. This dynamic was particularly present at the acute inpatient setting level. Further, findings suggest that service providers act as gateway providers to RTS for youth but only for those parents who do not have existing access to these settings. Implications for social work practice include that increasing caregiver knowledge about how to navigate mental health service systems across the continuum of care may improve their sense of empowerment to make decisions. Further, findings indicate that more resources and supports are needed for caregivers trying to access RTS for youth, particularly when trying to address acute behavioral crises.