This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of “medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medic-aid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.

This study examines the degree to which caregiver social connectedness influences the effects of strain associated with caring for a child with severe emotional disturbance (SED) on caregiver well‐being. We propose a model describing the relationships among the variables of interest and investigate elements of this model. Caregiver strain and social connections were significantly associated with caregiver well‐being. Although, no significant interaction effects of caregiver strain and social connections were detected, study findings suggest that caregiver well‐being can affect child progress and adjustment. Implications for child‐ and family‐serving systems are considered.

This study builds on the scant research involving siblings of children with severe emotional disturbances (SED) and examines: associations between adversity experiences and adjustment among 5- to 10-year-old siblings, and relations among family resources, community life, and sibling adjustment. Caregivers from 100 families completed standardized indicators of sibling adjustment and scales reflecting multiple contextual variables. Results document negative associations between stress exposure and sibling adjustment. Regression models also indicate positive associations between the caregiver–child relationship and broader family resources on sibling behavioral and emotional strengths, even after accounting for adversity experiences; adversity exposure was the prime correlate in regression models involving sibling oppositional behavior. Analyses also suggest that strain related to parenting a child with SED is associated with sibling adjustment. This work documents the needs of these siblings and their family systems and highlights the relevance of not only core proximal influences (e.g., child–caregiver relationship) but also elements of their broader contexts. Implications and recommendations are described, including the need to support plans of care that involve services, supports, or preventive strategies for these siblings.

Although socioeconomic status (SES) has been associated with a myriad of physical and psychological health indicators, it is arguably one of the most elusive constructs in the psychological literature. Most researchers agree that SES is complex and multidimensional; however, the majority of empirical studies that focus on SES do not measure (or attempt to measure) multiple components of the construct, instead focusing on one or two indicators of SES, most commonly household income and/or levels of education. This paper explores relationships among indicators of SES, disadvantage, and psychological well-being in two independent samples of families with children with severe emotional disturbances. In addition to utilizing two common SES indicators (parental education and income), we incorporated measures reflecting resource-related challenges of living, such as adequate food and housing. Based on analyses, we argue that such variables may better capture the challenges experienced by many families than traditional SES indicators. Findings also suggest that income and education relate to different aspects of family well-being, and solely using one or both of these variables may mask relevant relationships. Moreover, assessing practical, day-to-day challenges may permit a more nuanced picture of the relationships between factors associated with SES and indicators of well-being and adjustment.

In North Carolina, only 69% of high school students graduate in 4 years; however, recent data suggest that only 42% of students with mental and emotional disabilities graduate. MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. The SOC philosophy is a prominent family-focused approach intended to provide comprehensive, coordinated networks of services, tailored to the needs of the child and family, while emphasizing the strengthening of natural community supports. In addition to other mental health objectives, a particular goal of MeckCARES is to address specific school-based needs of system-identified youth to improve educational outcomes and reduce the risk of dropping out. This study sought to assess empirically the impact that enrollment in MeckCARES has on graduation precursors; namely, grades, suspensions, and absences. This study found that, on average, enrollment in MeckCARES is not associated with positive changes in educational variables. Implications of these findings are discussed, as are future directions. For example, additional research is needed with more sensitive measurement and data collection procedures (i.e., access to graduation rates and Medicaid information) to adequately assess the impact of enrollment in MeckCARES on educational outcomes.

Wraparound, the process by which families and professionals work in collaboration to help plan and implement services, has become the dominant practice model for providing services for children with severe emotional disturbances and their families (Faw 1999), particularly within Systems of Care (SOCs;Hernandez 2003;Stroul and Friedman 1986). The wraparound model consists of ten principles, including a team-based model for planning and implementation of services (Suter and Bruns 2009). These child and family teams (CFTs) are a central component of wraparound implementation. However, growing evidence suggests that the complex set of processes that define wraparound (Burns and Goldman 1999;VanDenBerg and Grealish 1996) are not implemented consistently, even in SOCs where the model is most supported. In fact, research suggests that many CFTs do not engage in many of the practices and processes considered central to wraparound implementation (Bruns et al. 2007;Cook et al. 2008;Walker and Schutte 2005). Although a growing body of literature has examined fidelity of wraparound implementation, factors that contribute to fidelity, and the relationship between fidelity and child and family outcomes, the importance of such factors as the level and stability of team members' participation over time have not been systematically examined.In a monograph produced by The National Implementation Research Network (NIRN; Fixsen et al. 2005), the authors synthesize the implementation literature across disciplines and describe core intervention components, stages of implementation, and outcomes for implementation or intervention. They also detail the multiple levels of influences on successful implementation, i.e.,

This study examined the factors influencing participant engagement in a home visiting program. Specifically, it explored the relationship between dosage and the constituent components of psychological resources: mental health, mastery, and cognitive resources. Multiple linear regression analyses were conducted utilising implementation data from a sample (n = 95) of participants in an Irish home visiting program. Psychological resources significantly predicted dosage, yet an investigation of each component found that only cognitive resources remained significant. Furthermore, when considering types of cognitive resources, verbal ability was found to significantly predict the number of home visits but not the average duration of visits. Conversely, perceptual reasoning was found to predict the average duration of home visits but not the number of home visits. These results suggest that cognitive resources may be the driving component behind previous findings that link psychological resources and level of dosage in home visiting programs. Practice and policy implications are explored.

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