Impact on the family resulting from children's emotional and behavioral problems, with particular attention to relationships between such family impact and use of mental health services, is explored in this article. Data come from the Great Smoky Mountains Study, an epidemiologic, longitudinal study of children's mental health problems and service use in a rural region of the southeastern United States. Reported measures include the Child and Adolescent Psychiatric Assessment, Child and Adolescent Service Assessment, and Child and Adolescent Impact Assessment. Youths who first used services when they were 10–15 years of age showed significantly higher rates and levels of family impact than similar youths who did not enter services. Such impacts were most notable in the areas of parental well-being (e.g., depression, worries) and parents' sense of competence to handle the child's problems. Youths in this age range who used services but were not new to the system showed somewhat higher rates of family impact than youths who were new to the system, particularly in the area of parental use of mental health services. We discuss these findings in terms of service provision and further research needs.
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