Therapeutic Staff Support, commonly known as TSS, provide one-on-one direct care (in home, school, and community settings) to children diagnosed with a severe emotional or behavioral disorder. In this dissertation I explore wraparound agencies practices of monitoring Therapeutic Staff Support treatment integrity. Using a qualitative design, 26 participants from three wraparound agencies were selected for this study. Data collection included interviews and documents (treatment plans, progress notes, and psychologist recommendations). Two primary research questions guided my inquiry into wraparound agencies monitoring practices of TSS: How do wraparound agencies monitor TSS treatment delivery? Does monitoring incorporate strategies for targeting TSS misutilization? Two secondary questions were: What are some potential threats to TSS treatment integrity? How do TSS address threats that directly affect students in schools? Findings suggest wraparound agencies use myriad methods to monitor TSS treatment adherence and accountability mechanisms adequately address TSS job performance. Similarly, I find agencies shape treatment document designs (plans and progress notes) to facilitate their use. Findings also point to five categories of issues which serve as potential threats to effective TSS treatment administration. I also find TSS misutilization was not a factor although there was no method of monitoring it. TSS did, however, find themselves performing multifaceted roles (often in response to threats directly affecting their students) which extended beyond their required roles of treatment agent and data collector; eight roles emerged. Ultimately, findings suggest documentation review and BSC observations are the most common approaches to monitoring TSS treatment integrity. Themes for threats (consistent with those found in other treatment literature) and themes used for TSS typology can be explored in future studies. / Urban Education

The purpose of this study was to identify if the rate of behavioral health rehabilitation services (BHRS) impacts depressive symptoms of mothers with children receiving these services and if the perception of social support moderates the severity of depression. The stress-buffering hypothesis and Bowen's family systems theory were used for the theoretical framework. A quantitative, cross-sectional survey design was used to collect data from mothers of children receiving BHRS Provider 50 services in northeast Pennsylvania. The Beck Depression Inventory, Second Edition and Multidimensional Scale of Perceived Social Support were used to assess depression and perceived social support. A self-made demographic form was used to identify the rate of BHRS and demographic characteristics. Linear regression and hierarchical multiple regression analyses were used to identify relationships between the study variables. According to study results, the rate of BHRS did not predict the severity of maternal depression, and perceived social support did not moderate the relationship between rate of BHRS and maternal depression. However, it was found that perceived social support was negatively correlated with the severity of maternal depression. This study provides information to the behavioral health community about maternal depression and raises awareness of the importance of caregiver well-being within the BHRS Provider 50 programs. Specifically, mothers caring for a child with special needs may benefit from additional support within a wraparound program.