Applying conservation of resources theory, we examined employment engagement (i.e., months of employment, hours worked per week, days of work missed due to the child’s challenges) among caregivers of children and youth entering community-based mental health service systems. The sample included 3,569 caregivers who were employed at some point in the previous 6 months. Variables associated with employment included family interactions, number of children in the household, caregiver age and gender, and caregiver race and ethnicity. The findings suggest that caregivers’ appraisals of their caregiving experiences were stronger predictors of work engagement than was child symptom severity. We concluded that supporting families as they care for children with emotional and behavioral disorders could reduce caregiver strain, thereby improving employment outcomes.

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Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.