“…While greater caregiver strain is associated with greater initial use of child mental health services (Brannan & Heflinger, 2006; Bussing, Mason, Leon, & Sinha, 2003; Cook et al, 2004; Garland, Aarons, Hawley, & Hough, 2003; Shin & Brown, 2009), it is also associated with long gaps in treatment (Brannan et al, 2003), poor service coordination (Yatchmenoff, Koren, Friesen, Gordon, & Kinney, 1998), and premature treatment drop-out in community mental health settings (Pellerin, Costa, Weems, & Dalton, 2010). Additionally, higher levels of caregiver strain predict use of more costly services, including psychiatric hospitalization (Bickman, Foster, & Lambert, 1996), residential or inpatient care (Brannan et al, 2003; Cook et al, 2004), and medication use (Cook et al, 2004). Subjective internalized strain in particular appears to be associated with receiving a higher level of care and more inconsistent care (Brannan et al, 2003).…”