1. Parents of Children with Emotional and Behavioral Disorders: Stress and School Service Satisfaction Martha Ellen Wynne, Ph.D., Eva Kowalewicz, M.Ed., Kathy Kula, M.Ed., Ruth Schumacher, M.Ed., Mary Satchwell, M.Ed. & Laura Swanlund, M.Ed.

2. Children with EBD and their Families At Loyola University, we tend to view problems through a lens of social justice as part of our mission. At Loyola University, we tend to view problems through a lens of social justice as part of our mission. Fewer than 1% of children are found eligible for special education services as a child with an emotional or behavioral disability. (U.S. Department of Education, 2005.) Fewer than 1% of children are found eligible for special education services as a child with an emotional or behavioral disability. (U.S. Department of Education, 2005.) At least 6 to 10% of students in elementary school have serious and persistent emotional/behavioral problems. At least 6 to 10% of students in elementary school have serious and persistent emotional/behavioral problems. By adolescence, up to 22% of students have mental health problems serious enough to warrant a DSM diagnosis (U.S. Department of Education, 2004). By adolescence, up to 22% of students have mental health problems serious enough to warrant a DSM diagnosis (U.S. Department of Education, 2004). Therefore, appropriately serving children with EBD is an issue of social justice because this is such an underserved population. Therefore, appropriately serving children with EBD is an issue of social justice because this is such an underserved population. 2

3. Types of Emotional and Behavioral Disorders (EBD) School and clinical behavior classification systems operate independently School and clinical behavior classification systems operate independently It is difficult for parents to navigate multiple systems It is difficult for parents to navigate multiple systems Parenting a child with a disability is stressful and interfacing with multiple professionals in schools and mental health agencies is also stressful Parenting a child with a disability is stressful and interfacing with multiple professionals in schools and mental health agencies is also stressful Parents are often blamed for their childs behaviors Parents are often blamed for their childs behaviors Blaming leads to difficulty in establishing parent-school partnerships Blaming leads to difficulty in establishing parent-school partnerships Positive parent relationships lead to better outcomes for all students (Christenson, 2004) Positive parent relationships lead to better outcomes for all students (Christenson, 2004)

4. The Present Study Little research has investigated the relationships among type and severity of student behavior problems, parental stress, and school services. Little research has investigated the relationships among type and severity of student behavior problems, parental stress, and school services. Research questions for the current study: Research questions for the current study: How does parent stress vary in relationship to the severity of their childs behavior problems? How does parent stress vary in relationship to the severity of their childs behavior problems? Is there a relationship between the severity of the childs rated EBD problems and the presence or absence of an IEP? Is there a relationship between the severity of the childs rated EBD problems and the presence or absence of an IEP? Is there a relationship between parent stress and the presence or absence of an IEP? Is there a relationship between parent stress and the presence or absence of an IEP? How does parent satisfaction with the adequacy of school services vary whether or not the child has an IEP? How does parent satisfaction with the adequacy of school services vary whether or not the child has an IEP? How does parent satisfaction with the adequacy of school services vary in relationship to their degree of reported stress? How does parent satisfaction with the adequacy of school services vary in relationship to their degree of reported stress?

5. Methodology Participants Participants 627 parents of children with EBD (ages 3-21 ) 627 parents of children with EBD (ages 3-21 ) 97% female, 92% Caucasian, 65% middle class or above 97% female, 92% Caucasian, 65% middle class or above Recruited from an online support group for parents of children with both internalizing and externalizing behavior problems Recruited from an online support group for parents of children with both internalizing and externalizing behavior problems See Table 1 in the handout for specific demographic information See Table 1 in the handout for specific demographic information

6. MethodologyInstruments Online survey instrument included: Online survey instrument included: Caregiver Strain Questionnaire (CSQ) (Brannan, Heflinger, Caregiver Strain Questionnaire (CSQ) (Brannan, Heflinger, & Bickman, 1997) Modified version of the Achenbach Child Behavior Checklist (Achenbach, 1991) Modified version of the Achenbach Child Behavior Checklist (Achenbach, 1991) Sample-specific survey questions addressing adequacy of educational programming Sample-specific survey questions addressing adequacy of educational programming Presence or absence of an IEP Presence or absence of an IEP Three Online survey instrument included: behavioral factors used in these analyses: Three Online survey instrument included: behavioral factors used in these analyses: Externalizing problems Externalizing problems Internalizing Problems Internalizing Problems Learning problems (including attention control/executive functioning) Learning problems (including attention control/executive functioning)

7. Results Parent Rating of Stress Parents were asked to complete the CSQ, which included rating 20 items on a 5-point scale measuring parent stress related to parenting a child with emotional and behavioral problems. Parents were asked to complete the CSQ, which included rating 20 items on a 5-point scale measuring parent stress related to parenting a child with emotional and behavioral problems. Factor analysis yielded three clear factors: General Family Stress, Negative Emotional Stress, and Financial Stress. Factor analysis yielded three clear factors: General Family Stress, Negative Emotional Stress, and Financial Stress. Parents reported highest means for General Family Stress, lowest for Financial Stress. Parents reported highest means for General Family Stress, lowest for Financial Stress. General Family Stress Mean = 3.72 General Family Stress Mean = 3.72 Negative Emotional Stress Mean = 3.03 Negative Emotional Stress Mean = 3.03 Financial Stress Mean = 2.34 Financial Stress Mean = 2.34 See Table 2 See Table 2

8. Combined Results Parent Rating of Stress Combined Parental Stress Measures: Combined Parental Stress Measures: 14% of parents reported low levels of combined stress 14% of parents reported low levels of combined stress 33% reported moderate levels of stress 33% reported moderate levels of stress 38% reported high levels of stress 38% reported high levels of stress 14% reported very high levels of stress 14% reported very high levels of stress Grand Mean for combined stress = 3.02 Grand Mean for combined stress = 3.02 (See Table 3) Over half of parents reported high or very high stress in parenting a child with EBD. Over half of parents reported high or very high stress in parenting a child with EBD.

9. Results Rating of Behavior Problems Parents were asked to rate the severity of their childs behavior problems on 22 items from the Achenbach CBCL using a 6-point scale Parents were asked to rate the severity of their childs behavior problems on 22 items from the Achenbach CBCL using a 6-point scale Factor analysis yielded three clear factors and each was found to be reliable: Externalizing Behaviors, α=.85, Internalizing Behaviors, α=.81, and Learning Problems, α=.92. Factor analysis yielded three clear factors and each was found to be reliable: Externalizing Behaviors, α=.85, Internalizing Behaviors, α=.81, and Learning Problems, α=.92. Parents reported highest severity ratings for behavior on the Learning Problems scale (Mean = 3.92, SD = 1.49), but the highest single item was Opposition/Defiance at Home on the Externalizing Scale (5.59) Parents reported highest severity ratings for behavior on the Learning Problems scale (Mean = 3.92, SD = 1.49), but the highest single item was Opposition/Defiance at Home on the Externalizing Scale (5.59) It is important to remember that although some of the means for individual items are below the mid-point, all the behaviors are undesirable, so even sometimes a problem is not something that a parent would wish for. (See Table 4) It is important to remember that although some of the means for individual items are below the mid-point, all the behaviors are undesirable, so even sometimes a problem is not something that a parent would wish for. (See Table 4)

10. Results Comparing Behavior Problems and Parent Stress Comparisons of all types of parental stress (General Family Stress, Negative Emotional Stress, and Financial Stress) and rated severity of childrens problem behaviors were significant (F(3,500)=42.423, p<.0001), with higher stress associated with increased severity of behavior. Comparisons of all types of parental stress (General Family Stress, Negative Emotional Stress, and Financial Stress) and rated severity of childrens problem behaviors were significant (F(3,500)=42.423, p<.0001), with higher stress associated with increased severity of behavior. When all three types of stress were combined, parents reported more stress as their childrens rated behavior problems increased in severity. When all three types of stress were combined, parents reported more stress as their childrens rated behavior problems increased in severity. This finding was consistent for Externalizing Behavior, (Somers d =.501, p<.0001); Internalizing Behavior, (Somers d =.46, p<.0001) ; and Learning Problems (Somers d =.22, p<.0001). This finding was consistent for Externalizing Behavior, (Somers d =.501, p<.0001); Internalizing Behavior, (Somers d =.46, p<.0001) ; and Learning Problems (Somers d =.22, p<.0001). See Table 5 for combined contingency results. See Table 5 for combined contingency results.

11. Presence or Absence of an IEP 63% of children had an IEP 63% of children had an IEP The right students were identified – students with more severe behaviors were more likely at a statistically significant level to have an IEP (p<.001). The right students were identified – students with more severe behaviors were more likely at a statistically significant level to have an IEP (p<.001).

12. IEPs and Severity of Behaviors Parents of students with IEPs rated their childs behavior problems as more severe than did parents of children without IEPs. Parents of students with IEPs rated their childs behavior problems as more severe than did parents of children without IEPs. Contingency analyses showed a significant relationship between severity of behaviors and presence or absence of an IEP (Somers d = -.213, p<.001). Contingency analyses showed a significant relationship between severity of behaviors and presence or absence of an IEP (Somers d = -.213, p<.001). Presence or Absence of an IEP Total YesNo Severity of Behavior Never a Problem 18217.9% Very Infrequently a Problem 5058 22.0 % Infrequently a Problem 12063 37.3 % Sometimes a Problem 9335 26.1 % Frequently a Problem 2856.7% Total62.9%37.1% 100.0 %

13. IEPs and Mean of Parent Stress Parents of students with IEPs reported more stress than parents of students who did not receive special education services. Parents of students with IEPs reported more stress than parents of students who did not receive special education services. ANOVA comparing the grand mean of stress scores for parents whose child received special education services with those who did not was significant (F, (1,455) = 7.08, p<.008. ANOVA comparing the grand mean of stress scores for parents whose child received special education services with those who did not was significant (F, (1,455) = 7.08, p<.008.

14. Parent Rating of Adequacy of Educational Programming Parents were asked to rate the adequacy of their childs educational program in addressing their childs needs. Parents were asked to rate the adequacy of their childs educational program in addressing their childs needs. Parents were most satisfied with the academic aspects of their childs educational program and least satisfied with the degree to which the program addressed their childs challenging behavior problems. Parents were most satisfied with the academic aspects of their childs educational program and least satisfied with the degree to which the program addressed their childs challenging behavior problems. See Table 6 for means and SD for ratings. See Table 6 for means and SD for ratings.

15. Parent Rating of Program Adequacy With and Without an IEP In all areas of programming but one, there were no significant differences between parental ratings of program adequacy and the presence or absence of an IEP In all areas of programming but one, there were no significant differences between parental ratings of program adequacy and the presence or absence of an IEP However, in the area of programming to address challenging behavior problems, parents of students with IEPs were significantly more satisfied (F (1,463) = 6.322, p <.012) than parents of students without IEPs. However, in the area of programming to address challenging behavior problems, parents of students with IEPs were significantly more satisfied (F (1,463) = 6.322, p <.012) than parents of students without IEPs. 15

16. Program Adequacy and Parent Stress with IEPs There was a significant relationship between parental rating of educational program adequacy and stress when children had IEPs. There was a significant relationship between parental rating of educational program adequacy and stress when children had IEPs. Within each cell, the relationship was negative and linear, i.e., the higher the satisfaction with the adequacy of the programming, the lower the stress level. Within each cell, the relationship was negative and linear, i.e., the higher the satisfaction with the adequacy of the programming, the lower the stress level. Each of the six programming areas was significant at p <.01 level. Each of the six programming areas was significant at p <.01 level. 16

17. Program Adequacy and Parent Stress without IEPs For students without IEPS, the relationship between rated program adequacy and parental stress was similar and significant for 5 of 6 areas. For students without IEPS, the relationship between rated program adequacy and parental stress was similar and significant for 5 of 6 areas. However, for students without IEPs, there was no relationship between adequacy of programming to reduce challenging behavior problems and parental stress. However, for students without IEPs, there was no relationship between adequacy of programming to reduce challenging behavior problems and parental stress. Regardless of stress level, parents rated behavioral programming adequacy as low. Regardless of stress level, parents rated behavioral programming adequacy as low. 17

18. Discussion Overall, what do these data tell us and what are the implications for socially just practice in school psychology? Overall, what do these data tell us and what are the implications for socially just practice in school psychology? A summary of the major points will precede considering the implications for practice. A summary of the major points will precede considering the implications for practice.

19. Summary First, there is a strong and consistent relationship between the severity of the childs behavioral problems and all types of parental stress. First, there is a strong and consistent relationship between the severity of the childs behavioral problems and all types of parental stress. Cross-sectional research cannot establish causality, but looking at the content of the stress items, it is unlikely that the types of parental stress assessed would precede the childs behavior problems. Cross-sectional research cannot establish causality, but looking at the content of the stress items, it is unlikely that the types of parental stress assessed would precede the childs behavior problems. 19

20. Summary Second, the students with the most severe problems are more likely to have IEPs. Second, the students with the most severe problems are more likely to have IEPs. Parents of students with IEPs are more stressed, but probably due to the severity of the children behavioral problems rather than the presence of an IEP Parents of students with IEPs are more stressed, but probably due to the severity of the children behavioral problems rather than the presence of an IEP 20

21. Summary In general, parents are more satisfied with the adequacy of academic programming than behavioral programming. In general, parents are more satisfied with the adequacy of academic programming than behavioral programming. Parents of students with IEPs are less stressed when programming in all 6 educational areas is more adequate. Parents of students with IEPs are less stressed when programming in all 6 educational areas is more adequate. Parents of students without IEPs are equally stressed regardless of their rating of the adequacy of their childs behavioral programming. Parents of students without IEPs are equally stressed regardless of their rating of the adequacy of their childs behavioral programming. 21

22. Implications As indicated, even in this underserved population, the right students have IEPs because students with more severe behavioral problems have IEPs at a higher rate. However, we know that over 1/3 were unserved despite the overall presence of problematic behavior and 84% of the sample having DSM diagnoses Schools should strengthen interventions for behavioral needs of students in this population while continuing to address academic needs.

23. Implications More connection between home and school may be possible because parents tend to rate academic programs positively, countering the stereotype that parents of EBD students do not care about education. More connection between home and school may be possible because parents tend to rate academic programs positively, countering the stereotype that parents of EBD students do not care about education. Rather than being in denial about their childs behavior, parents in this population are in distress, and clearly would like to receive more help with their very difficult- to-parent children. Rather than being in denial about their childs behavior, parents in this population are in distress, and clearly would like to receive more help with their very difficult- to-parent children. School personnel should guard against negative stereotyping parents of students with EBD Recognition of the difficulty in parenting a child with serious behavioral and emotional problems will help professionals work more effectively with parents. Recognition of the difficulty in parenting a child with serious behavioral and emotional problems will help professionals work more effectively with parents. 23

24. Limitations of the Sample The use of on-line parent samples, which are more educated and affluent than the underlying population of parents of children with EBD in general, possibly positively skewed the results, and we acknowledge this. The use of on-line parent samples, which are more educated and affluent than the underlying population of parents of children with EBD in general, possibly positively skewed the results, and we acknowledge this. However, it is unlikely that less educated or economically disadvantaged parents would fare better in managing stress in their families while attempting to obtain help for their children. However, it is unlikely that less educated or economically disadvantaged parents would fare better in managing stress in their families while attempting to obtain help for their children. 24

25. Closing & Questions Thank you for attending our presentation. Thank you for attending our presentation. The Power Point presentation and handout will be available on NASPs website. The Power Point presentation and handout will be available on NASPs website. Questions? Questions?

26. Parents of Children with Emotional and Behavioral Disorders: Stress and School Service Satisfaction Martha Ellen Wynne, Ph.D., Eva Kowalewicz, M.Ed., Kathy Kula, M.Ed., Ruth Schumacher, M.Ed., Mary Satchwell, M.Ed. & Laura Swanlund