Redefining and Reconciling “Stress” Among Child Welfare Involved Caregivers: A Mixed Methods Approach to Understanding Psychological Distress and Its Relationship to Financial Hardship

Background & Purpose: The family stress model (FSM) posits that the day-to-day strain associated with economic hardship generates psychological distress that can disrupt parenting and impact children’s developmental outcomes. Child welfare-involved families disproportionately experience economic hardship, reflecting broader inequalities that shape both system involvement and family stress. Unconditional cash interventions are designed to stabilize financial insecurity to improve parental mental health and promote adaptive parenting practices. However, research on stress reduction and cash transfers has shown mixed effects with most results finding no effects on stress suggesting that the interplay between financial and mental health is complex. Using a convergent parallel mixed methods design, the purpose of this descriptive study is to describe the extent and nature of psychological distress among child welfare-involved caregivers. With this empirically grounded caregiver-centered perspective, we can improve how we measure and interpret psychological distress outcomes associated with cash interventions.

Methods: Data from a baseline survey (n=315) of caregivers enrolled in the Empower Parenting with Resources (EmPwR) Study were analyzed using descriptive statistics to assess three manifestations of caregiver distress. Qualitative data from 92 baseline and 6-month surveys were analyzed using a matrix analysis approach to describe and explain challenging experiences in families’ lives. Qualitative and quantitative data were compared using visual displays to identify patterns of concordance and discordance in lived experiences of “stress” and quantitative measures of associated constructs.

Results: Descriptive analyses of psychological distress and emotional wellbeing scales indicate generally low or moderate levels of negative outcomes for this sample of child welfare involved caregivers. Most caregivers reported low or moderate stress on the Perceived Stress Scale (83.4%). Similarly, a majority endorsed low levels of anxiety (71.8%) on the BAI. Depression scores were largely below the threshold for clinical significance (72.5%) as measured with the PHQ-8. Qualitative findings align with quantitative results. Although caregivers describe situations that objectively appear to be challenging, they do not consistently interpret or frame these experiences as highly stressful. Taken together, findings suggest that caregivers appraise difficult situations in varied and nuanced ways.

Conclusions & Implications: Comparisons of quantitative scores and qualitative narratives indicate that caregivers lived experiences of psychological distress may not always be perceived as highly challenging. This implies that results from this bank of stress measures should be interpreted with caution and in alignment with caregivers’ perspectives. Standardized stress measures may not entirely capture caregivers lived experiences, potentially leading to misinterpretation of self-reported low stress. These findings suggest interventions may not want to solely on scale-based thresholds to assess felt stress. Rather, quantitative findings should be interpreted alongside qualitative content to better understand how welfare-involved caregivers evaluate and normalize stress. Additionally, future research should develop and adapt measures that better reflect the mental constructs around stress of those with lived experience.