Jan S. Greenberg - US grants

This small grant proposal explores the physical and mental health of aging parents caring for an adult child with severe mental illness. The subjective and objective burdens of having severely mentally ill family member, often called family burden, are high, and may vary depending on the informal and formal supports provided to families. Along with the burdens of providing care, aging parents experience additional sources of stress associated with age-related changes and losses. Though increasing numbers of aging parents are providing care for a mentally ill child, little is known about the burdens they face, their use of mental health and related services, and the impacts of caregiving on their physical and mental health and related services, and the impacts of caregiving on their physical and mental health. The objectives of this study are: (1) to describe the objective and subjective burdens experienced by aging parents caring for a mentally ill adult child; (2) to identify factors that are associated with lower levels of caregiver burden; (3) to describe more precisely the extent to which formal services to the mentally ill adult child and the family serve as a "buffer" to parental stress; (4) to generate hypotheses for future research on the mental health service needs of aging parents as caregivers to their mentally ill adult children. As part of a study on the impact of lifelong caregiving, data have been collected in Wisconsin on 225 mothers, age 55 and over, who care for an adult child with mental retardation. An additional objective will be to compare the impact of caregiving on aging parents of adult children with mental retardation and mental illness. This exploratory investigation will be accomplished through a nonexperimental, cross-sectional study of 100 mothers, age 55 and older, living with a severely mentally ill adult child. For 2-parent households, fathers also will be asked to participate. Parents of clients who are receiving publicly funded mental health services in Dane County, WI. will be sampled. Data will be gathered using a 2 hour face-to-face interview conducted in the respondent's home. Mothers and fathers will be interviewed separately. The interview will focus on the parent's experience of burden, the use of mental health and related services, unmet service needs, and other critical factors such as the use of coping strategies, and the reliance on informal supports.

The proposed study examines mental health services and mental health service systems as these are related to caregiver burden with families having a severely mentally ill member. The subjective and objective burdens of having a severely mentally ill family member, often called family burden, are often high and may vary depending on the advice, support, crisis help, and other mental health services provided to family members. this perspective recognizes the general proposition that burdens placed on families caring for ill members are important outcomes of health care systems. This proposed research would describe what types of mental health services to family members contrasting family burden across systems of services which are selected to provide wide variations in mental health services to family members and to patients. The study would have a non-experimental design, examining the natural variation of experiences of burden within 689 families each having a severely mentally ill member in treatment within nine public mental health systems. These nine county-based systems of care in Wisconsin represent diverse intervention strategies including 1) predominantly inpatient, 2) CSP team, 3) social caseworker model, 4) patients having one-on-one contacts with para-professionals, and 5) lay persons as case manager extenders. Variation within county systems in the type and amount of services family members receive will also be examined. Data will be gathered using a 1/2 hour long telephone interview with family members concerning their experiences of burden, the services they received, their patient's behavior, other stressors impacting the family, attributions by the family concerning the patient's behavior, and family attempts to cope with the behavior.

DESCRIPTION (provided by applicant): This is the third submission of this training application (T32 MH065185), previously reviewed by the NIMH Special Emphasis Panel [ZMH1-NRB-W (01)]. The application was developed in response to the NIMH program announcement for NRSA Institutional Training Grants. The focus of this revised predoctoral training program is on the mental health and service needs of family caregivers. The program will include 7 trainees during the 5-year grant cycle, with two new students joining the training program in years 1-3, and one new trainee in year 4. Students will enter with an MSW, and research or clinical experience in mental health. The goals of the program are (1) to encourage talented students to focus their graduate study and conduct dissertation research on the mental health and service needs of family caregivers, (2) to instill in these students a long-term commitment to conducting research on the mental health and service needs of family caregivers, and (3) to provide students with the methodological, statistical, and substantive expertise needed to fulfill that commitment. This training program will be housed at, and fully integrated into the School of Social Work, University of Wisconsin-Madison. Trainees will have opportunities to participate in research activities being conducted in six interdisciplinary campus institutes or centers. The doctoral program in social work takes four years to complete for students entering with a master's degree. Trainees will be funded by the training grant for 3 years at which time they will be guaranteed continued support as a research assistantship until completion of their dissertation. All trainees will participate in training program activities throughout their doctoral studies, continuing to benefit from the structure, resources, and mentoring that the program provides. The training program includes 7 core faculty and 13 affiliated faculty. Core faculty have their tenured or tenure track appointment in social work, and have an externally funded program of research which will afford students opportunities to conduct dissertation research on the mental health and service needs of family caregivers. Affiliated faculty are tenured faculty members with appointments outside of the Social Work who bring expertise in specialized areas that will complement the expertise of the core faculty members. A National Advisory Committee consisting of 13 leading scholars in the field of family caregiving and mental health services research will enrich the resources of the proposed program.