Child, caregiver, and family predictors of rates of growth in clinical and functional outcomes in systems of care
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Over the last several decades there has been a growing recognition that children with serious emotional disturbances are considerably underserved. The Comprehensive Community Mental Health Services for Children and Their Family Program is the largest federal grant program to help communities to implement, advance, and evaluate the system of care approach to service delivery. One of the goals of the evaluation has been to determine if children who participate in system of care services demonstrate improved clinical and functional outcomes over time. Prior research has revealed that children do display significant improvements over time. While this research is promising, it is also important to explore the variability in the rates of improvement to determine who benefits the most from system of care services. This dissertation explores the predictive role of a selected group of variables (behavioral and emotional strengths, caregiver strain, and demographic variables) on differential rates of improvements in clinical and functional outcomes over time for children who participate in systems of care. These variables were also examined in relation to differences in levels of clinical and functional impairments at intake into system of care services. The results from the latent variable quadratic growth models indicated that children who are served by systems of care displayed significant improvements in clinical and functional outcomes over time, with the greatest improvement occurring in the first six months. Children's behavioral and emotional strengths, caregiver strain, sex, age, and race significantly predicted differences in instantaneous growth, as well as rates of deceleration, for clinical and functional outcomes. Clinical implications, limitations of the study, and directions for future research are discussed.