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Objective-To describe the state of the literature on stigma associated with children's mental disorders and highlight gaps in empirical work.Method-We reviewed child mental illness stigma articles in (English only) peer-reviewed journals available through Medline and PsychInfo. We augmented these with adult-oriented stigma articles that focus on theory and measurement. 145 articles in PsychInfo and 77 articles in MEDLINE met search criteria. The review process involved identifying and appraising literature convergence on the definition of critical dimensions of stigma, antecedents, and outcomes reported in empirical studies.Results-We found concurrence on three dimensions of stigma (negative stereotypes, devaluation and discrimination), two contexts of stigma (self, general public), and two targets of stigma (self/ individual, family). Theory and empirics on institutional and self stigma in child populations were sparse. Literature reports few theoretic frameworks and conceptualizations of child mental illness stigma. One model of help-seeking (the FINIS) explicitly acknowledges the role of stigma in children's access and utilization of mental health services.Conclusions-Compared to adults, children are subject to unique stigmatizing contexts that have not been adequately studied. The field needs conceptual frameworks that get closer to stigma experiences that are causally linked to how parents/caregivers cope with children's emotional and behavioral problems such as seeking professional help. To further research in child mental illness, we suggest an approach to adapting current theoretical frameworks and operationalizing stigma highlighting three dimensions of stigma, three contexts of stigma (including institutions), and three targets of stigma (self/child, family and services).

The impact on the family of having a family member with serious emotional problems has been an area of concern as deinstitutionalization and managed care have shifted treatment to the community and primary caregiving to the family. Measures are needed to assess caregiver strain in a way that can lead to a better understanding of the phenomena, improve clinical interventions, and examine the outcomes of new treatment modalities on the client's family. In order to study the effects of this treatment shift, the Caregiver Strain Questionnaire (formerly the Burden of Care Questionnaire) was developed for use with families of children and adolescents with emotional and behavioral disorders. Findings from exploratory and confirmatory factor analyses support the existence of three related but unique dimensions of strain experienced by parents of this population. This study adds to the current body of knowledge by suggesting that subjective caregiver strain has two components, and not the single form claimed in previous research. The results also indicate that the Caregiver Strain Questionnaire is a reliable and valid scale for the measurement of caregiver strain among families of children with emotional or behavioral disorders. T HE EXPERIENCES OF PARENTS ORother caregivers of individuals with mental or physical health problems have been recognized increasingly as critical factors for influencing both the ability of those individuals to live successfully in the community and their utilization of community-based services. The mental health reform efforts of the past several decades, and the more recent move toward managed care, have shifted treatment of individuals who would previously have been cared for in hospital settings to the community. As a result, today's mental health systems rely increasingly on families. The impact has been recognized as stressful for families of both adults and children with serious mental or physical health problems, including (a) adults with schizophrenia and other severe and persistent mental disorders (Carpentier,

This study used a prominent model of family stress and coping to examine whether caregiver and family variables predicted child mental health service utilization patterns, holding constant the child clinical and demographic variables.We were especially interested in the impact of caregiver strain on children's use of mental health services. We found caregiver strain to be associated with the combination of services used, sequencing of services, gaps in care, and cost of services. Other family variables that predicted children's service use included material resources, life events, and family functioning. Child clinical variables improved the explanatory power of the models considerably. When all other variables were included in the model, child's age was the only demographic variable that predicted service use patterns. et al., 1987). Once in services, older children tend to use more services (Realmutto et al., 1992;Roghmann et al., 1982) and experience more restrictive levels of care