Child & Youth Care Forum

, Volume 45, Issue 5, pp 759–780 | Cite as

Caregiver Perspectives During the Post Inpatient Hospital Transition: A Mixed Methods Approach

  • Angela M. BlizzardEmail author
  • Catherine L. Weiss
  • Rukiya Wideman
  • Sharon H. Stephan
Original Paper



Knowledge of caregiver perspectives of their psychosocial resources and needs during the post inpatient psychiatric hospitalization is limited. Examining caregivers’ perspectives of the transition period may be a critical step in improving the transition success of children with emotional and behavioral disorders. Using quantitative and qualitative methods, we investigated the psychosocial resources and needs of caregivers after a child inpatient hospitalization.


This study sought to examine the psychosocial resources of caregivers of children leaving intensive psychiatric care and participating in a post-inpatient transition program, and to describe their reported needs at home and school.


Forty-four caregivers were recruited from the child and adolescent psychiatric inpatient units of two hospitals (one urban, one suburban). We utilized a partially mixed concurrent equal status design for mixed-methods analysis. Qualitative data were analyzed using consensual qualitative research methodology.


Caregivers reported high levels of strain, child symptomatology, and low levels of empowerment and social support. Their satisfaction with school and mental health services were mixed. Caregivers identified a need for increased knowledge of behavior management strategies, improved caregiver/child relationship, more emotional support, and increased access to services for their children. Areas of concern in the school setting included social–emotional functioning, learning, access to school services, and advocacy.


These findings expand our knowledge of caregivers’ psychosocial resources and needs during their children’s inpatient psychiatric hospitalization and subsequent transition to home and school. As research in this area develops, we suggest that incorporating caregivers’ needs into transition planning may result in more effective and acceptable interventions for families.


Mental health services Caregiver Inpatient psychiatric care School 



Funding for this work was provided by the Maryland Department of Health and Mental Hygiene, 1915(c) Community Alternatives to Psychiatric and Residential Treatment Facilities Demonstration Waiver Program Management, Workforce Development and Evaluation, 13-10954G/M00B3400369. We would like to acknowledge David Pruitt, M.D., Sarah Edwards, D.O., Nancy Lever, Ph.D., Carrie Mills, Ph.D., Michael Green, LCSW-C, Courtney Vaughan, LCSW-C, Tierra Sydnor, LGSW, Lorette Vetusi, M.A., Fatima Logan, Krista Kutash, Ph.D., and Al Duchnowski, Ph.D for their contributions to the School Transition Program.


  1. Altman, D. G. (1990). Practical statistics for medical research. Chicago: CRC Press.Google Scholar
  2. Angold, A., Messer, S. C., Stangl, D., Farmer, E. M., Costello, E. J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88(1), 75–80.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Ascher, B. H., Farmer, E. M., Burns, B. J., & Angold, A. (1996). The child and adolescent services assessment (CASA) description and psychometrics. Journal of Emotional and Behavioral Disorders, 4(1), 12–20.CrossRefGoogle Scholar
  4. Baker, B. L., Blacher, J., Crnic, K. A., & Edelbrock, C. (2002). Behavior problems and parenting stress in families of three-year-old children with and without developmental delays. American Journal on Mental Retardation, 107(6), 433–444.CrossRefPubMedGoogle Scholar
  5. Brannan, A. M., Athay, M. M., & de Andrade, A. R. V. (2012). Measurement quality of the caregiver strain questionnaire-short form 7 (CGSQ-SF7). Administration and Policy in Mental Health and Mental Health Services Research, 39(1–2), 51–59.CrossRefPubMedGoogle Scholar
  6. Brannan, A. M., & Heflinger, C. A. (2001). Distinguishing caregiver strain from psychological distress: Modeling the relationships among child, family, and caregiver variables. Journal of Child and Family Studies, 10(4), 405–418.CrossRefGoogle Scholar
  7. Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The caregiver strain questionnaire measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5(4), 212–222.CrossRefGoogle Scholar
  8. Brannan, A. M., Heflinger, C. A., & Foster, E. M. (2003). The role of caregiver strain and other family variables in determining children’s use of mental health services. Journal of Emotional and Behavioral Disorders, 11(2), 77–91.CrossRefGoogle Scholar
  9. Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the brief cope. International Journal of Behavioral Medicine, 4(1), 92–100.CrossRefPubMedGoogle Scholar
  10. Casey, K. J., Reid, R., Trout, A. L., Hurley, K. D., Chmelka, M. B., & Thompson, R. (2010). The transition status of youth departing residential care. Child & Youth Care Forum, 39(5), 323–340.CrossRefGoogle Scholar
  11. Causey, D. L., McKay, M., Rosenthal, C., & Darnell, C. (1998). Assessment of hospital-related stress in children and adolescents admitted to a psychiatric inpatient unit. Journal of Child and Adolescent Psychiatric Nursing, 11(4), 135–145.CrossRefPubMedGoogle Scholar
  12. Deane, F. P., Skogstad, P., & Williams, M. W. (1999). Impact of attitudes, ethnicity and quality of prior therapy on New Zealand male prisoners’ intentions to seek professional psychological help. International Journal for the Advancement of Counselling, 21(1), 55–67.CrossRefGoogle Scholar
  13. Dunst, C. J., Jenkins, V., & Trivette, C. M. (1984). Family support scale: Reliability and validity. Journal of Individual, Family, and Community Wellness, 1(4), 45–52.Google Scholar
  14. Fontanella, C. A. (2008). The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents. American Journal of Orthopsychiatry, 78(2), 187.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.CrossRefPubMedGoogle Scholar
  16. Graves, K. N., & Shelton, T. L. (2007). Family empowerment as a mediator between family-centered systems of care and changes in child functioning: Identifying an important mechanism of change. Journal of Child and Family Studies, 16(4), 556–566.CrossRefGoogle Scholar
  17. Hall, H. R., & Graff, J. C. (2011). The relationships among adaptive behaviors of children with autism, family support, parenting stress, and coping. Issues in Comprehensive Pediatric Nursing, 34(1), 4–25.CrossRefPubMedGoogle Scholar
  18. Harrison, M. E., McKay, M. M., & Bannon, W. M, Jr. (2004). Inner-city child mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40(2), 119–131.CrossRefPubMedGoogle Scholar
  19. Heflinger, C. A., Northrup, D. A., Sonnichsen, S. E., & Brannan, A. M. (1998). Including a family focus in research on community-based services for children with serious emotional disturbance: Experiences from the Fort Bragg Evaluation Project. In M. Epstein, K. Kutash, A. Duchnowski (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices, (pp. 261–293). Austin, TX: ProEd.Google Scholar
  20. Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52(2), 196.CrossRefGoogle Scholar
  21. Hill, N. E., & Taylor, L. C. (2004). Parental school involvement and children’s academic achievement pragmatics and issues. Current Directions in Psychological Science, 13(4), 161–164.CrossRefGoogle Scholar
  22. Hill, C. E., Thompson, B. J., & Williams, E. N. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25(4), 517–572.CrossRefGoogle Scholar
  23. Hinshaw, S. P. (2005). The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry, 46(7), 714–734.CrossRefPubMedGoogle Scholar
  24. Ireys, H. T., & Sakwa, D. D. (2006). Building family-to-family support programs: Rationale, goals, and challenges. Focal Point, 20(1), 10–14.Google Scholar
  25. Kerkorian, D., Bannon, W. M., & McKay, M. (2006). Seeking help a second time: Parents’/caregivers’ characterizations of previous experiences with mental health services for their children and perceptions of barriers to future use. American Journal of Orthopsychiatry, 76(2), 161–166.CrossRefPubMedGoogle Scholar
  26. Koren, P. E., DeChillo, N., & Friesen, B. J. (1992). Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology, 37(4), 305.CrossRefGoogle Scholar
  27. Kovacs, S., & Sharp, C. (2014). Criterion validity of the strengths and difficulties questionnaire (SDQ) with inpatient adolescents. Psychiatry Research, 219(3), 651–657.CrossRefPubMedGoogle Scholar
  28. Kutash, K., Duchnowski, A. J., Green, A. L., & Ferron, J. M. (2011). Supporting parents who have youth with emotional disturbances through a parent-to-parent support program: A proof of concept study using random assignment. Administration and Policy in Mental Health and Mental Health Services Research, 38(5), 412–427.CrossRefPubMedGoogle Scholar
  29. Kutash, K., Duchnowski, A. J., Green, A. L., & Ferron, J. (2013). Effectiveness of the parent connectors program: Results from a randomized controlled trial. School Mental Health, 5(4), 192–208.CrossRefGoogle Scholar
  30. Leech, N. L., & Onwuegbuzie, A. J. (2009). A typology of mixed methods research designs. Quality & Quantity, 43(2), 265–275.CrossRefGoogle Scholar
  31. Littlewood, K., Swanke, J. R., Strozier, A., & Kondrat, D. (2012). Measuring social support among kinship caregivers: Validity and reliability of the Family Support Scale. Child Welfare, 91(6), 59–78.PubMedGoogle Scholar
  32. Mayberry, L. S., & Heflinger, C. A. (2013). How caregivers make meaning of child mental health problems: Toward Understanding caregiver Strain and help seeking. Families in Society: The Journal of Contemporary Social Services, 94(2), 105–113.CrossRefGoogle Scholar
  33. McCubbin, H. I., & Patterson, J. M. (1983). The family stress process: The double ABCX model of adjustment and adaptation. Marriage & Family Review, 6(1–2), 7–37.CrossRefGoogle Scholar
  34. Minnes, P., Perry, A., & Weiss, J. A. (2015). Predictors of distress and well-being in parents of young children with developmental delays and disabilities: The importance of parent perceptions. Journal of Intellectual Disability Research, 59(6), 551–560. doi: 10.1111/jir.12160.CrossRefPubMedGoogle Scholar
  35. Moore, B. C., Biegel, D. E., & McMahon, T. J. (2011). Maladaptive coping as a mediator of family stress. Journal of Social Work Practice in the Addictions, 11(1), 17–39.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Olin, S. S., Hoagwood, K. E., Rodriguez, J., Ramos, B., Burton, G., Penn, M., & Jensen, P. S. (2010). The application of behavior change theory to family-based services: Improving parent empowerment in children’s mental health. Journal of Child and Family Studies, 19(4), 462–470.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Preyde, M., & Ardal, F. (2003). Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. Canadian Medical Association Journal, 168(8), 969–973.PubMedPubMedCentralGoogle Scholar
  38. Puotiniemi, T. A., Kyngäs, H. A., & Nikkonen, M. J. (2002). The resources of parents with a child in psychiatric inpatient care. Journal of Psychiatric and Mental Health Nursing, 9(1), 15–22.CrossRefPubMedGoogle Scholar
  39. Rappaport, J. (1981). In praise of paradox: A social policy of empowerment over prevention. American Journal of Community Psychology, 9, 1–25.CrossRefPubMedGoogle Scholar
  40. Resendez, M. G., Quist, R. M., & Matshazi, D. G. (2000). A longitudinal analysis of family empowerment and client outcomes. Journal of Child and Family Studies, 9(4), 449–460.CrossRefGoogle Scholar
  41. Riley, S. E., Stromberg, A. J., & Clark, J. (2005). Assessing parental satisfaction with children’s mental health services with the youth services survey for families. Journal of Child and Family Studies, 14(1), 87–99.CrossRefGoogle Scholar
  42. Savina, E., Simon, J., & Lester, M. (2014). School reintegration following psychiatric hospitalization: An ecological perspective. Child & Youth Care Forum, 43(6), 729–746.CrossRefGoogle Scholar
  43. Scharer, K., & Jones, D. S. (2004). Child psychiatric hospitalization: The last resort. Issues in Mental Health Nursing, 25(1), 79–101.CrossRefPubMedGoogle Scholar
  44. Simon, A. E., Pastor, P. N., Reuben, C. A., Huang, L. N., & Goldstrom, I. D. (2015). Use of mental health services by children ages six to 11 with emotional or behavioral difficulties. Psychiatric Services, 66(9), 930–937.CrossRefPubMedGoogle Scholar
  45. Simon, J. B., & Savina, E. A. (2007). Facilitating hospital to school transitions: practices of hospital-based therapists. Residential Treatment for Children & Youth, 22(4), 49–66.CrossRefGoogle Scholar
  46. Simon, J. B., & Savina, E. A. (2010). Transitioning children from psychiatric hospitals to schools: The role of the special educator. Residential Treatment for Children & Youth, 27(1), 41–54.CrossRefGoogle Scholar
  47. Singh, N. N., Curtis, W. J., Ellis, C. R., Nicholson, M. W., Villani, T. M., & Wechsler, H. A. (1995). Psychometric analysis of the family empowerment scale. Journal of Emotional and Behavioral Disorders, 3(2), 85–91.CrossRefGoogle Scholar
  48. Stroul, B. A., & Friedman, R. M. (1986). A system of care for severely emotionally disturbed children & youth. Washington, DC: Georgetown University Child Development Center.Google Scholar
  49. Taub, J., Tighe, T. A., & Burchard, J. (2001). The effects of parent empowerment on adjustment for children receiving comprehensive mental health services. Children’s Services: Social Policy, Research, and Practice, 4(3), 103–122.CrossRefGoogle Scholar
  50. Taylor-Richardson, K. D., Heflinger, C. A., & Brown, T. N. (2006). Experience of strain among types of caregivers responsible for children with serious emotional and behavioral disorders. Journal of Emotional and Behavioral Disorders, 14(3), 157–168.CrossRefGoogle Scholar
  51. Vaughan, E. L., Feinn, R., Bernard, S., Brereton, M., & Kaufman, J. S. (2013). Relationships between child emotional and behavioral symptoms and caregiver strain and parenting stress. Journal of Family Issues, 34(4), 534–556.CrossRefPubMedGoogle Scholar
  52. Weiss, C. L., Blizzard, A. M., Vaughan, C., Sydnor-Diggs, T., Edwards, S., & Stephan, S. H. (2015). Supporting the transition from inpatient hospitalization to school. Child and Adolescent Psychiatric Clinics of North America, 24(2), 371–383.CrossRefPubMedGoogle Scholar
  53. Wilson, C. J., & Deane, F. P. (2001). Adolescent opinions about reducing help-seeking barriers and increasing appropriate help engagement. Journal of Educational and Psychological Consultation, 12(4), 345–364.CrossRefGoogle Scholar
  54. Zimmerman, M. A., & Rappaport, J. (1988). Citizen participation, perceived control, and psychological empowerment. American Journal of Community Psychology, 16(5), 725–750.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Angela M. Blizzard
    • 1
    Email author
  • Catherine L. Weiss
    • 2
  • Rukiya Wideman
    • 3
  • Sharon H. Stephan
    • 2
  1. 1.Department of PsychologyFlorida International UniversityMiamiUSA
  2. 2.Division of Child and Adolescent Psychiatry, Department of PsychiatryUniversity of Maryland, School of MedicineBaltimoreUSA
  3. 3.Department of PsychologyUniversity of Maryland, Baltimore CountyBaltimoreUSA

Personalised recommendations