A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Children and teens with behavioral health disabilities may have symptoms that make it harder for them to participate in school and other activities. These symptoms may include feelings such as anxiety or depression, as well as behaviors such as aggression or noncompliance with authority figures. Children and teens with behavioral health disabilities may require a great deal of support from their parents or other caregivers, who are often responsible for coordinating specialized educational, healthcare, and other services as well as responding to crises. Holding a paid job may provide these caregivers with many resources to support their children, including income, reliable health insurance, social support, and a sense of meaning and balance for the caregiver. However, caregivers may find it challenging to balance the responsibilities of caring for a child or teen with behavioral health disabilities and the responsibilities of holding a paid job outside the home. For example, caregivers may need to reduce their work hours or need to miss a day of work if their child experiences a crisis or needs intensive treatment. In a recent NIDILRR-funded study, researchers asked people caring for children and teens with behavioral health disabilities about their employment experiences. They wanted to find out what factors were related to the amount of time that the caregivers spent in paid employment. They also wanted to find out what factors were related to caregivers needing to miss work to attend to their children’s behavioral health needs.
Researchers at the Rehabilitation Research and Training Center for Pathways to Positive Futures looked at data from the Longitudinal Child and Family Outcome Study (LCFOS), a study of families of children and teens receiving behavioral health treatment in service systems supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) between 2004 and 2011. The data were collected from interviews with caregivers of children ages 6-17 who reported engaging in paid work within the last 6 months. During the interviews, the caregivers answered questions about their employment experience during the previous 6 months, including the following: how many months they had been employed, how many hours per week they had worked, and the total number of workdays they had missed due to their children’s behavioral health needs. The caregivers also answered questions about the level of strain they experienced as a result of caregiving, including “objective” strain (how much their family encountered problems such as financial challenges, a lack of free time, or disrupted relationships as a result of the child’s behavioral health disability) and “subjective” strain (how often they experienced feelings of sadness, guilt, worry, anger, resentment, or embarrassment related to their child’s behavioral health disability). Finally, the caregivers answered questions about the severity of their child’s behavioral health symptoms, and provided demographic information about their gender, age, race/ethnicity, and how many children they had living in their home.
The researchers found that the caregivers reported being employed for an average of 5.2 months out of the previous 6 months and working nearly full-time at about 35 hours per week, on average. The caregivers reported missing about one workday per month on average because of their children’s behavioral health needs. The caregivers whose children had more severe behavioral health symptoms missed more workdays than the caregivers of children with less severe symptoms.
When the researchers looked at the link between caregiver strain and employment, the researchers found that:
- Regardless of the children’s symptom severity, the caregivers reporting more objective strain worked fewer hours per week than the caregivers reporting less objective strain. However, caregivers reporting more subjective strain, particularly feelings of anger, resentment or embarrassment, worked more hours per week than those reporting less subjective strain.
- Regardless of the children’s symptom severity, the caregivers reporting more objective strain missed more workdays than the caregivers reporting less objective strain. Again, the opposite pattern was seen with subjective strain: the caregivers reporting more anger, resentment, and embarrassment related to their children’s disability reported missing fewer workdays than the caregivers reporting less of these feelings.
- In addition, caregivers who were white, male, or who had fewer children living in their homes worked more hours per week than the caregivers who were African American or other races, female, or who had more children. The caregivers who were African American or Hispanic reported missing more workdays due to their child’s disability than the caregivers who were white.
The authors noted that the objective strain of caring for a child or teen with a behavioral health disability may make it difficult for caregivers to fully engage in paid employment. In particular, disruptions to family life and relationships can lead caregivers to reduce their work hours or miss work to attend to family issues. This may, in turn, increase financial challenges for the family. Even when caregivers can balance work and caring for their child, the stress of managing that balance may lead to subjective strain like feelings of anger or embarrassment. Social workers and other service providers may assist caregivers in building their social support networks so that families can respond to crises or disruptions without the caregiver needing to miss work or increasing their stress levels. In addition, service providers may wish to ensure that family support services are culturally relevant and responsive to individuals from non-white racial backgrounds.
To Learn More
The RRTC on Pathways to Positive Futures offers a range of publications, webinars, and other resources for young people with mental health conditions and their families, as well as the professional and peer support personnel who work with these families. Among these resources you’ll find:
- Strengthening Family Support for Young People with Mental Health Needs in the Transition to Adulthood: A Tip Sheet for Service Providers https://www.pathwaysrtc.pdx.edu/pdf/projPTTC-FamilySupportTipSheet.pdf
The Family Support Rehabilitation Research and Training Center focuses on synthesizing and generating knowledge about the needs and experiences of families who provide support to children and adults with disabilities across the life course.
The National Alliance on Mental Illness is a national non-profit organization dedicated to bettering the lives of people affected by mental illness. Visit their collection of resources for family caregivers or find a local office to connect to resources in the community.
To Learn More About this Study
Brannan, A.M., Brennan, E.M., Sellmaier, C., & Rosenzweig, J.M. (2018) Employed parents of children receiving mental health services: Caregiver strain and work–life integration. Families in Society, 99(1), 29-44. This article is available from the NARIC collection under Accession Number J78562.
This study was also supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).