Satisfaction with Life Scale (SWLS) in Caregivers of Clinically-Referred Youth: Psychometric Properties and Mediation Analysis

This paper presents the psychometric evaluation of the Satisfaction with Life Scale (SWLS; Diener et al. in J Personal Assess 49:71-75, 1985) used with a large sample (N = 610) of caregivers for youth receiving mental health services. Methods from classical test theory, factor analysis, and item response theory were utilized. Additionally, this paper investigated whether caregiver strain mediates the effect of youth symptom severity on caregiver life satisfaction (N = 356). Bootstrapped confidence intervals were used to determine the significance of the mediated effects. Results indicated that the SWLS is a psychometrically sound instrument to be used with caregivers of clinically-referred youth. Mediation analyses found that the effect of youth symptom severity on caregiver life satisfaction was mediated by caregiver strain but that the mediation effect differed based on the type of youth symptoms: caregiver strain was a partial mediator when externalizing symptoms were measured and a full mediator when internalizing symptoms were measured. Implications for future research and clinical practice are discussed.     

The Session Report Form (SRF): Are Clinicians Addressing Concerns Reported by Youth and Caregivers?

This study explores the relationship between clinician-reported content addressed in sessions, measured with the Session Report Form (SRF), and multi-informant problem alerts stemming from a larger battery of treatment process and progress measures. Multilevel Multinomial Logit Models were conducted with 133 clinicians and 299 youths receiving home-based treatment (N = 3,143 sessions). Results indicate a strong relationship between session content and problems related to youth symptoms and functioning as reported by clinicians in the same session. Session content was related to emotional, family, and friend/peer problems reported by youth and youth behavioral problems reported by caregivers. High-risk problems (alcohol/substance use, harm to self or others) were strongly related to session content regardless of informant. Session content was not related to problem alerts associated with the treatment process, caregiver strain, or client/caregiver strengths. The SRF appears to be a useful measure for assessing common themes addressed in routine mental health settings.     

Validation and Use of the Youth and Caregiver Treatment Outcome Expectations Scale (TOES) to Assess the Relationships Between Expectations, Pretreatment Characteristics, and Outcomes

This study introduces the youth and caregiver versions of the Treatment Outcome Expectations Scale (TOES) and presents the results of comprehensive psychometric analyses in a large sample of clinically-referred youth (N = 291) ages 11-18 and their caregivers (N = 268). This study also examines whether expectations are predictive of early or overall treatment change as measured by changes in youth symptom severity rated by multiple respondents (youth, caregiver, and clinician). Additionally, the relationship between treatment outcome expectations and several background, pretreatment, and clinical variables is explored. Finally, this study investigates the correspondence in outcome expectations between dyads of youth and caregivers. Results demonstrate the TOES is a psychometrically sound measure for use in this population. Findings also indicate that while higher youth outcome expectations significantly relate to higher youth-rated internalizing symptom severity at baseline, they also relate to a faster rate of reduction in internalizing symptom severity. Additionally, caregiver age and youth gender were significant predictors of youth-rated outcome expectations. Results also demonstrate a small, positive correlation between youth and caregiver ratings of outcome expectations. Implications, future directions, and limitations of the study are discussed.     

Youth and Caregiver Access to Peer Advocates and Satisfaction with Mental Health Services

Access to peer advocates is increasingly available to youth and their caregivers who are receiving services in the public mental health system. This study examines associations between reported access to a youth or family advocate and perceptions of satisfaction with mental health services. A cross-sectional survey of youth (N = 768) and caregivers (N = 1,231) who utilized public mental health services in New York State in 2012 was conducted. The survey includes items on access to youth or family advocates and degree of satisfaction with mental health services. A greater proportion of youth or caregivers with access to peer advocates compared to those without access responded positively on the satisfaction domains of access to services, appropriateness of services, participation in services and overall/global satisfaction. Access to peer advocates was also positively associated with agreement on the psychotropic medication comprehension domain for youth and on perceptions of child functioning and social connectedness for caregivers compared to those without access. This study adds to the growing understanding of the important role peer advocates play in engaging youth with mental health needs and their caregivers in mental health services.     

Racial and ethnic differences in utilization of mental health services among high-risk youths

OBJECTIVE: Racial and ethnic disparities in mental health service use have been identified as a major public health problem. However, the extent to which these disparities may be accounted for by other confounding sociodemographic or clinical predictors of service use (e.g., family income, functional impairment, caregiver strain) is relatively unexplored, especially for youth services. The goal of this study was to test for racial/ethnic disparities in use of a variety of outpatient, inpatient, and informal mental health services among high-risk youths, with the effects of other predictive factors controlled. METHOD: Participants were 1,256 youths ages 6-18 years who received services in a large, publicly funded system of care (including the child welfare, juvenile justice, special education, alcohol and drug abuse, and mental health service sectors). Youths and caregivers were interviewed with established measures of mental health service use, psychiatric diagnoses, functional impairment, caregiver strain, and parental depression. RESULTS: Significant racial/ethnic group differences in likelihood of receiving any mental health service and, specifically, formal outpatient services were found after the effects of potentially confounding variables were controlled. Race/ethnicity did not exert a significant effect on the use of informal or 24-hour-care services. CONCLUSIONS: Racial/ethnic disparities in service use remain a public health problem.     

Motivation for Youth’s Treatment Scale (MYTS): A New Tool for Measuring Motivation Among Youths and Their Caregivers

Treatment motivation can be important for treatment adherence and outcomes, yet few measures of motivation are available for youths in mental health settings. These authors describe the psychometric properties of the motivation for youth's treatment scale (MYTS), an 8-item measure with forms for youths and caregivers that assesses their problem recognition and treatment readiness. Results indicate that the MYTS offers practitioners and researchers a brief, psychometrically sound tool for assessing treatment motivation of youths and their caregivers. Multivariate analyses of clinical and non-clinical characteristics of youths and caregivers show that youths' symptom severity consistently predicts treatment motivation for both groups. However, the strain of caring for the youth adds significantly to caregivers' recognition of the youth's troubles. While caregiver and youth motivations correlate, their agreement is low. Caregivers are nearly always more treatment motivated than youths. The authors discuss the implications of their findings for measurement, treatment planning, and future research.     

Relationship Between Caregiver Hopefulness and Satisfaction with their Children’s Mental Health Services

Relationships among the Youth Services Survey for Families (YSSF) Indicators, selected demographic and clinical variables, and caregiver-rated hopefulness and children’s problem severity were examined in a random sample of 1,500 caregivers of Medicaid-enrolled youth in a satisfaction study with Kentucky’s 14 community mental health centers. Multiple linear regressions revealed that caregiver services and caregiver hopefulness were excellent predictors of two and three YSSF Indicators, respectively. Providers need to respond to caregiver concerns when developing support services and understand the mechanisms associated with these services’ effectiveness. Tracking changes in caregiver and youth hopefulness during treatment may improve services and retention and bridge the gap between research and the important construct of hope.     

Caregiver causal attributions in youth psychosis

Aim: Caregiver causal attributions influence patient and caregiver reactions to psychosis. The current study describes common caregiver causal attributions about psychosis onset in youth, including a subset of first‐episode psychosis patients, and the patient and caregiver characteristics that influence these attributions. It also examines if caregiver views are affected by contact with youth mental health services. Methods: Fifty‐one caregivers of 50 youth patients with a diagnosed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) psychotic disorder were interviewed about their causal attributions. Patient and caregiver demographic and clinical predictors were also collected. Results: Caregivers most highly endorsed substance use, genetics, negative peer influences and school stress as individual causes. These findings were consistent across the total sample. Principal components analysis derived three causal categories. Caregivers most frequently endorsed a biological and substance use lifestyle causal category, followed by psychological vulnerability and stress‐reactivity causal categories. There was evidence that caregiver and patient factors, as well as contact with youth mental health services, influenced the causal attributions caregivers made about the onset of psychosis. Conclusion: Caregivers of youth with psychosis are making causal attributions that are consistent with current aetiological theories of psychosis in youth. The study showed that caregivers are particularly cognizant of genetic and substance use factors in the development and maintenance of psychosis. However, youth mental health services may need to particularly focus on increasing caregiver understanding of the dynamics of stress factors as symptoms, and not causes, of psychosis early in the illness course.     

Primary stressors and depressive symptoms in caregivers of dementia patients

Pearlin et al . (1990) propose a model for examining the wellbeing of caregivers of dementia patients. The present paper focuses on one part of this model, examining the relationship between primary stressors and mental health, particularly depression, in a cross-sectional sample of 91 caregivers of dementia patients. The primary stressors examined are: patient cognitive status, objective burden, subjective burden and generalized perceived stress. Linear and non-linear relationships between patient cognitive status and caregiver depression were considered. Some evidence was found for a non-linear relationship between patient cognitive status and caregiver depression, but only the interaction between subjective caregiving burden and generalized perceived stress was found to significantly predict caregiver depression when all variables were considered. Implications for including global as well as caregiver-specific measures of subjective burden in models of caregiver wellbeing are discussed.     

Relationships Between Youth and Caregiver Strengths and Mental Health Outcomes in Community Based Public Mental Health Services

To examine relationships between youth and caregiver strengths and behavioral health outcomes for youth in community service settings. Strengths and behavioral health needs of youth (N = 793) receiving Home and Community Based Services Waiver from 2002–2008 were characterized using the child and adolescent needs and strengths mental health assessment. Comparisons of assessment scores at admission and program completion were conducted using Chi-square, repeated measures ANOVA and Cohen’s d effect size. Associations between strengths at admission and having behavioral health needs met were examined using multivariable logistic regression. Youth had high levels of needs on mental health, risk and functioning dimensions at admission. All needs improved significantly over the course of the service episode. Youth and caregiver strengths at admission were associated with significant improvements in youth behavioral needs areas at discharge. The findings support the importance of assessing and incorporating youth and caregiver strengths in planning and delivering public mental health services.     

Patients' and relatives' satisfaction with psychiatric services: The state of the art of its measurement

Despite reservations made on its use as a means for evaluating interventions, various findings in the recent literature point to patients' and relatives' satisfaction with psychiatric services as a particularly salient and appropriate measure of outcome and quality. Even though substantial improvements have occurred in the last decade, research in the field suffers various methodological limitations regarding the study design, the instruments' construction and the lack of attention to their psychometric properties. In the last few years the need for research that develops and refines measures of client satisfaction and establishes their psychometric properties has been considered a priority in service evaluation by a growing number of authors. In spite of this, in the mental health field very few validated instruments for the measurement of satisfaction are currently available. The aims of the present paper were: (1) to update work done in the field of satisfaction with mental health services in the last decade; (2) to describe the main instruments currently available to measure patients' and relatives' satisfaction with mental health services; (3) to provide guidelines for the future development of instruments and their use in mental health settings. The author concludes by emphasizing that, in order to make further progress, considerable effort is needed in developing and spreading the use of validated instruments and discouraging the use of ad hoc measures. Comparability between studies should be pursued more vigorously in order allow both the refinement of existing instruments and a better understanding of the theoretical and substantive meaning of satisfaction with psychiatric services.     

Validation and use of the Children’s Hope Scale-Revised PTPB Edition (CHS-PTPB): High Initial Youth Hope and Elevated Baseline Symptomatology Predict Poor Treatment Outcomes

The present study examined the relationship between initial youth hope, measured within the first 4 weeks of mental health treatment, and treatment progress over time (self-, caregiver-, and clinician-report of symptom severity) in a clinical sample of youth ages 11-18 years (N = 356). The psychometric properties of the CHS-PTPB, a revised version of the Children's Hope Scale, are also presented. Results indicate the CHS-PTPB is a psychometrically sound measure for use in this population. Additionally, results found that while higher levels of hope were associated with lower levels of symptom severity at baseline, initial level of hope was not significantly related to symptom improvement over time as reported by the youth and caregiver. Surprisingly, higher initial hope predicted slower treatment progress as rated by clinicians. According to clinician-rated symptom severity, youth with high initial hope and high baseline symptom severity show the poorest predicted clinical outcome. Implications, future directions, and limitations of the study are discussed.     

Measurement and correlates of family caregiver self-efficacy for managing dementia

Researchers in the aging field are paying increasing attention to the importance of perceived self-efficacy in understanding experiences and health-related outcomes of family caregivers. This paper details the strategy we used to measure family caregiver self-efficacy for managing dementia, and reports on observed associations between the resulting self-efficacy measures, caregiver depressive symptoms, and caregiver physical health symptoms. Family caregivers (n = 197) were interviewed after calling a local Alzheimer's Association chapter in the mid-western USA. Nine items inquiring about caregivers' certainty that they could carry out specific behaviors related to dementia care clustered into two distinct self-efficacy factors: symptom management self-efficacy (4 items) and community support service use self-efficacy (5 items). Internal consistency reliability for both factors was high (Cronbach's alpha = 0.77 and 0.78, respectively). Symptom management self-efficacy demonstrated a much stronger correlation with a published global caregiver competence measure than did service use self-efficacy (r = 0.49 and 0.27, respectively). In a multivariate regression model predicting caregiver depression symptoms, higher symptom management self-efficacy scores were associated with fewer depressive symptoms (beta = -0.17, p < 0.05). In a separate model, higher service use self-efficacy scores (beta = -0.20, p < 0.01) and higher symptom management self-efficacy scores (beta = -0.16, p < 0.05) were associated with fewer physical health symptoms. These new measures of dementia management self-efficacy hold promise for use in future studies.     

The Relationship Between Change in Therapeutic Alliance Ratings and Improvement in Youth Symptom Severity: Whose Ratings Matter the Most?

This paper presents the psychometric evaluation of brief measures of therapeutic alliance (TA) for youths, clinicians and caregivers and a longitudinal analysis of relationships between changes in TA and changes in youth symptom and functioning severity. Psychometric analyses using methods from Classical Test Theory, Item Response Theory, and Factor Analysis indicate that the measures of TA used in this study offer something new for both practice and research. The measures have variability, sensitivity to change over time, brevity and can be used with multiple parties through parallel forms. The longitudinal analyses, employing hierarchical linear modeling with time-varying covariates, found that TA ratings of the clinician correlated with symptom improvement as rated by the clinician, caregiver and youth. Additional analyses showed that decreases in clinician-rated youth TA was most important in predicting a lower rate of youth improvement. Implications for future research and clinical practice are discussed.     

The Symptoms and Functioning Severity Scale (SFSS): Psychometric Evaluation and Discrepancies Among Youth, Caregiver, and Clinician Ratings Over Time

This paper describes the development and psychometric evaluation of the symptoms and functioning severity scale (SFSS), which includes three parallel forms to systematically capture clinician, youth, and caregiver perspectives of youth symptoms on a frequent basis. While there is widespread consensus that different raters of youth psychopathology vary significantly in their assessment, this is the first paper that specifically investigated the discrepancies among clinician, youth, and caregiver ratings throughout the treatment process within a community mental health setting. Results for all three respondent versions indicated the SFSS is a psychometrically sound instrument for use in this population. Significant discrepancies in scores existed at baseline among the three respondents. Longitudinal analyses reveal the youth-clinician and caregiver-clinician score discrepancies decreased significantly over time. Differences by youth gender existed for caregiver-clinician discrepancies. The average youth-caregiver score discrepancy remained consistent throughout treatment. Implications for future research and clinical practice are discussed.     

A model for developing outcome measures from the perspectives of mental health service users

It is becoming increasingly recognized that conventionally derived outcome measures in mental health research are problematic. This is both because of the methodology used and because a 'good' outcome is framed from the perspective of clinicians and researchers. This paper describes a methodology for developing outcome measures for use in large studies entirely from the perspective of mental health service users. It is a mixed methods model starting with a participatory and qualitative methodology and proceeding to psychometric testing. At all stages, the researchers are themselves mental health service users. In the first phase of the model, focus groups are convened comprising people who have received the treatment or service being measured. The focus groups meet twice resulting in a draft mixed-methods questionnaire devised from thematic analysis of the focus group data. This is then taken to expert panels, again comprising individuals who have received the treatment or service being evaluated for refinement. Following this, a feasibility study is conducted with N?～?50 participants and changes made iteratively to the questionnaire in light of feedback. The final measure is subject to psychometric testing both to ensure it is robust and to explore similarities and differences with conventionally derived measures.     

Caregiver depression and medication use by youths with ADHD who receive services in the public sector

OBJECTIVE: This study examined caregiver depression and medication use by youths with attention-deficit hyperactivity disorder (ADHD) in the public sector. METHODS: Multivariate logistic regression models were created for 390 youths six to 17 years of age who met ADHD criteria on the Diagnostic Interview Schedule for Children (DISC) and were enrolled in a prospective study of youths served in public-sector service systems. The dependent variable was caregiver report of youth medication use for ADHD in the 12 months before the 24-month interview. RESULTS: Only 38% of youths with DISC diagnoses of ADHD were using medication. Youths whose caregivers had depression (41% of the sample) were half as likely as other youths to use medication. Younger age, public insurance, caregiver report of diagnosis, and receipt of medical, mental health, or school services also predicted use. CONCLUSIONS: Caregiver depression and its association with medication use warrant further exploration.     

Sexual and Drug Use Behavior in Perinatally HIV− Infected Youth: Mental Health and Family Influences

ObjectiveAs perinatally human immunodeficiency virus (HIV)? infected (PHIV+) youths enter adolescence, they are at high risk for poor behavioral and health outcomes. This study examines relations between youth mental health problems and sexual and substance use risk behavior, the impact of caregiver mental health and family functioning on youth mental health and risk behavior outcomes, and the role of youth HIV status in this process.MethodParticipants were recruited from four medical centers. Individual interviews were administered to 193 PHIV+ and 127 perinatally HIV exposed but uninfected (PHIV?) 9- to 16-year-old boys and girls and their primary caregivers. Participants were primarily African American and Latino. The interview assessed child sexual and drug risk behavior, child and caregiver mental health, and family functioning.ResultsExploratory latent-variable structural equation modeling revealed no differences in rates of sexual risk behavior or substance use between PHIV+ and PHIV? youths. However, adolescent mental health was significantly associated with sexual risk behavior and substance use. Caregiver mental health was associated with youth mental health and indirectly with sexual risk behavior and drug use through its impact on youth mental health. Family functioning did not significantly predict youth outcomes.ConclusionsOver and above other key environmental factors and family functioning, youth and caregiver mental health problems are related to sex and drug use risk behaviors in PHIV+ and PHIV? youths. Given high rates of youth and caregiver mental health problems in this population, family-based mental health interventions may be a key component of HIV prevention programs for perinatally HIV? exposed youth.