Caregiver strain among biological, foster, and adoptive caregivers caring for youth receiving outpatient care in a public mental health system

Abstract

Caregivers of children with mental health disorders often report high levels of stress. Although children in the child welfare system have high rates of mental health problems, to date, little is known about the stress experienced by foster and adoptive caregivers. The purpose of the present study was to examine differences in both internalized (e.g., worry and guilt) and externalized (e.g., anger and resentment) caregiver strain among biological, foster and adoptive caregivers, and assess the degree to which characteristics of the caregivers and the children in their care impact strain. Caregivers of youth under age 18 who were receiving treatment in a publically-funded mental health system completed the Caregiver Strain Questionnaire (CSQ), along with the Youth Services Survey for Families (YSSF) which has questions about the youth’s functioning and the mental health care he or she is receiving. A total of 1828 caregivers returned surveys that were eligible for analyses. Generalized Estimating Equations were used examine associations between caregiver type and internalized and externalized strain while controlling for caregiver demographics and social support, and youth demographics, functioning, and time in treatment.Results show that foster and adoptive caregivers reported experiencing less internalized strain than biological caregivers. Caregiver type was not significantly related to feelings of externalized strain. Several additional caregiver and youth characteristics were associated with both types of strain, and caregivers with higher levels of social support experienced less strain. Providers working with children with mental health disorders, particularly those in the child welfare system, should assess families for caregiver strain and provide and/or facilitate supports for caregivers with high levels of stress. Finally, additional research is needed to identify which types of interventions may be most effective for alleviating caregiver strain.