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Here, I venture into the sociology of the professions to discuss the impact of empowerment evaluation on the autonomy of its practitioners. I do so because I found the process of conducting an empowerment evaluation to be challenging during the first four years of a Substances and Mental Health Services Administration (SAMHSA) system-of-care (SOC) mental health services transformation for youth with serious emotional disturbance (SED). My goal is to offer readers some suggestions about how to avoid these challenges in the future.

Organizations conduct external evaluations for several reasons. They might want an independent assessment showing that their program is effective to garner community support, favorably influence public policy related to their mission, support their future bids for financial support, provide critical information for continuous quality assessment (although much of the latter is conducted internally by the organizations themselves), or because an external evaluation is required under the terms of a grant they received. The author focuses on the latter and argues that the quality of these evaluations is dependent on the continued involvement of funding agencies after the grant is awarded. He suggests four things that funders can do to address this challenge.

How do youth from various community groups designated as having a serious emotional disturbance (SED) recover over time? We conducted an evaluation of a Substance Abuse and Mental Health Services Administration System of Care grant initiative for Monroe County, New York, to answer this and other questions. We looked at outcome differences over time using the Behavioral and Emotional Ratings Scale's (2nd ed.) overall strength scores among youth living in four geographical places at the start of services: high-income urban, low-income urban, suburban, and rural. Minorities (be they nonwhite or white) within each group, except suburban, had the higher probability of being designated as having SED. We found recovery disparities among white urban youth and their nonurban counterparts, and among nonwhite suburban and high-income urban youth and their low-income urban and rural counterparts. Applied implications include the following: (a) Continue the restructuring of mental health and juvenile justice agencies to become more culturally competent, (b) create a social marketing campaign to address the stigma surrounding mental illness, (c) build coalitions to publicize risk factors to mental health and their prevention, (d) restructure schools away from the prevailing eurocentric model of education, and (e) create a labor hour exchange for the repair and upgrade of housing and other infrastructure.

To what extent might race and where one lives at service start in Monroe County, New York, influence three dimensions of caregiver strain among those caring for a youth designated as having serious emotional disturbance? We used the Caregiver Strain Questionnaire to measure our outcomes: subjective internalizing strain—negative feelings of guilt and worry associated with having a child with behavioral and emotional problems; subjective externalizing strain—negative feelings about the child such as anger or embarrassment; and objective strain—interruption of personal time, lost work time, and/or financial strain in four geographical areas (place of residence) defined by ZIP code. These places included Low Income Urban (median ZIP code household income less than $39,000), High Income Urban (median ZIP code household income greater than or equal to $39,000), Suburban, and Rural.We found that place at service start and time predicted caregiver strain levels (though time was the only predictor for externalizing strain), controlling for several factors. Race had no detectable influence. Supports can be individualized to a greater extent to address specific factors influencing the type of strain experienced by a caregiver. Providers might begin by identifying caregiver strain by type and intensity as well as identifying the specific circumstances leading to feelings and concerns associated with each type of caregiver strain.