Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Community and Family Health

Major Professor

Bruce L. Levin, Ph.D.

Co-Major Professor

Rita Debate, Ph.D.

Committee Member

Julie Baldwin, Ph.D.

Committee Member

John Ferron, Ph.D.

Committee Member

Krista Kutash, Ph.D.


burden of care, emotional disturbance, school mental health, special education


Broadly, the purpose of this study was to address the gaps in the knowledge base of caregiver strain through an examination of this and other theoretically related constructs in a sample of parents of high-risk youth. In the last two decades, a growing body of research has pointed to the significance of strain that can result from this caregiving experience, particularly as it relates to patterns of mental health services utilization. Despite the fact that the majority of children who receive mental health receive them from the school, few studies have examined caregiver strain in the context of school-based mental health services or with caregivers of youth in special education for Emotional Disturbance (ED). Additionally, while the Modified Double ABCX Model of family stress and coping has been identified as a useful model to understand caregiver strain and its related constructs, questions remain about how all of the components of this model work together to influence caregiver strain and the mechanism by which caregiver strain influences youth mental health service use and parent engagement in services. The specific aims of this study were to: (1) explore the construct of caregiver strain and its relationship with theoretically related constructs in caregivers of youth in special education for ED, and (2) examine the factors, including caregiver strain, that predict school-based mental health services utilization and parent engagement in services.

Secondary analyses were conducted using data collected as part of a randomized controlled trial of a parent support intervention for caregivers of youth in special education for ED. Participants included 112 caregivers and you their youth recruited from 22 schools and special education centers. Data were provided by caregivers and school-based mental health service providers. Caregivers completed phone interviews conducted upon entry into the study and again approximately nine months later. These semi-structured interviews included measures of youth functioning, caregiver strain, and caregivers’ perceptions related to their child’s problems and engagement in services. School-based mental health service providers supplied data related to the amount of school-based mental health counseling services received by youth and whether caregivers consulted with service providers during the study period. Data were analyzed using a variety of quantitative methods, including descriptive statistics, dependent samples t-tests, one-way ANOVA, Structural Equation Modeling (SEM), multiple linear regression, and multiple logistic regression.

Results revealed that caregivers reported the highest levels of subjective-internalizing strain, and that the level of three types of caregiver strain decreased from time 1 to time 2. Additionally, caregivers of males tended to report higher levels of strain than caregivers of females, and parents tended to report higher levels of strain than other caregivers. Consistent with previous studies, non-Hispanic Black caregivers tended to report the lowest levels of caregiver strain compared to all other racial/ethnic groups. Findings from SEM analyses revealed that following slight modifications to the originally hypothesized model, the model tested fit the data well and all of the paths included in the model (other than those related to race/ethnicity) had statistically significant parameter estimates. Findings from the multiple linear regression analyses revealed that collectively the predictors included in the model accounted for only a small percentage of the variance in the outcome (11.9%), and none of the predictors included in the regression model significantly predicted the amount of school-based counseling received by students. Results from the multiple logistic regression analyses revealed that only youth gender and youth conduct problems were significant predictors of the outcome; caregivers of male youth and caregivers of youth with more conduct problems were less likely than caregivers of female youth and caregivers of youth with fewer conduct problems, respectively, to have consulted with their child’s school-based mental health services provider during the school year.

Collectively, findings from this study demonstrate that caregivers of youth in special education for ED experience caregiver strain to a similar degree as caregivers of youth receiving services through mental health systems. Further, findings provide evidence for the usefulness of the Modified Double ABCX Model in studying and understanding caregiver strain in this population. While findings from this study provide support for the relationships among the constructs of this model, findings from this study also suggest that this model may not hold up in terms of predicting the amount of school-based services received by youth or the likelihood of parent engagement with their child’s school-based mental health service provider. Additional research is needed that includes a more complete representation of the constructs of this model to determine if this model holds for school-based service use and engagement.