Advances in treatment now enable the survival into young adulthood of up to 90% of children with once fatal conditions such as cancer, cystic fibrosis, and neurodegenerative diseases (Cohen et al., 2011; Perrin, Guyer, & Lawrence, 1992). Unlike their healthy peers, these adolescent and young adult (AYAs) survivors often have personal (e.g., delayed developmental milestones, employment, interpersonal relationships), medical (e.g., increasing health complications), and institutional (e.g., economics, education, insurance changes, transportation, transition to adult health care) challenges impeding their transition to independence. Their caregivers, usually their mothers, typically live dramatically altered lives and often continue to function in primary caregiving roles as these children enter adulthood (James et al., 2002; Kuo, Cohen, Agrawal, Berry, & Casey, 2011). Often unpredictable, these caregiving demands may remind them that their children are vulnerable and undermine how competent they feel as caregivers (Gravelle, 1997; Maltby, Kristjanson, & Coleman, 2003). Caregivers of AYA childhood brain tumor survivors share similar experiences with caregivers of AYA with other serious health conditions because their children survived longer than expected, have multiple chronic conditions, and face challenges when transitioning to independence (Eiser, Eiser, & Greco, 2002). The tumors and their treatment (i.e., surgery, chemotherapy, and cranial and/or spinal irradiation) can result in late effects, including one of the most severe risk profiles for childhood cancer survivors (chronic morbidities and reduced health-related quality of life) and for their caregivers (ongoing care demands) (Deatrick, Mullaney, & Mooney-Doyle, 2009; Forinder & Norberg, 2010; Hutchinson, Willard, Hardy, & Bonner, 2009; Oeffinger et al., 2006; Radcliffe, Bennett, Kazak, Foley, & Phillips, 1996). To better understand the functioning of these caregivers, particularly their demands and competency, a review of the empirical literature and a related theoretical model by Raina and colleagues (2004) were used to construct the hypothesized model for this study (see Figure 1). Raina’s stress process model is based on life span caregiving research to predict the psychological and physical health of caregivers according to the following domains: background and contextual factors, child characteristics, caregiver stress/strain, intrapsychic factors, and coping/supportive factors (Raina et al., 2004). In subsequent research, the domains in the model were empirically supported in studies of the psychological and physical health of caregivers for infants, children, and adolescents with serious critical and chronic conditions and cancer (Klassen et al., 2007; Klassen et al., 2011; Raina et al., 2005). These domains were used in the model for this study (see Table 1 and Figure 1). Figure 1 Perceived competence for caregivers of childhood brain tumor survivors. Depicted are the domains for the conceptual model and measures for the study. Measures are (1) Pediatric oncology Quality of Life Measure (POQOL); (2) Survivor Demographic Form; (3) ... Table 1 Comparison of Raina (2004) and Perceived Competence Models: Domains, Factors, Variables, and Measures The health of the survivor, caregiver, and family are central to the hypothesized model in terms of their influence on caregiver demands. Survivor health includes their emotional health-related quality of life (HRQL), physical HRQL, cognitive late effects, age, time since treatment, treatment intensity, medical sequelae, and life threat because of their risk for complex morbidities and caregiver demands (Oeffinger et al., 2006). Caregiver health includes overall psychological functioning, state anxiety, trait anxiety, posttraumatic stress symptoms, marital status, and physical health, all of which have been identified as being critical to performing as caregivers and meeting the demands of childhood cancer survivors, including brain tumors (Klassen et al., 2007; Litzelman, Catrine, Gangnon, & Witt, 2011). Therefore, caregiver heath transitioned from being an outcome in Raina’s (2004) Model to influencing caregiving demand in this study. Because caregivers and survivors do not function in isolation, evaluation must also extend to the role of the family in determining how caregivers experience the demands of their role. Specifically, family functioning is important in explaining cognitive and behavioral outcomes in children and AYA with brain tumors (Carlson-Green, Morris, & Krawiecki, 1995; Foley, Barakat, Herman-Liu, Radcliffe, & Molloy, 2000; Hocking et al., 2011). Family functioning includes the ability of the family to work as a unit with the caregiver as well as their economic resources because better family functioning and financial resources are associated with the perception of fewer caregiver demands in general childhood cancer populations (Hutchinson et al., 2009; Klassen et al., 2011). In families of brain tumor survivors, members are often concerned about the following factors: the survivors’ abilities before and after treatment; implications of the brain tumor for the future of the child and family; balance between the needs of the family and needs of the child; amount of time and work taken for condition management; ability to meet the needs of the child over the long-term within the context of loss and recovery; and relationships, shared views, mutual support, and flexibility (Anclair, Hoven, Lannering, & Boman, 2009; Aukema, Last, Meeteren, & Grootenhuis, 2011; Deatrick et al., 2009). These concerns continue to impact the family well into adulthood (Hoven, Lannering, Gustafsson, & Boman, 2011; Hutchinson et al., 2009), and therefore family functioning is included in the model for this study as influencing caregiver demand along with survivor and caregiver health. Caregiving demands are also potentially important to the perceived competence of the caregiver and are examined in most research conducted with caregivers of young children with complex conditions including brain tumors (Hutchinson et al., 2009). The demands or burdens experienced by caregivers are associated with reports of their health; caregivers who experience more demands report less optimal health (Klassen et al., 2007; Klassen et al., 2011; Raina et al., 2004; Vance, Eiser, & Horne, 2004). As Raina proposed, caregivers who perceive that their survivor has less than optimal health undergo more caregiver demands (Bandura, 1991; Hoven et al., 2011), a relationship which is also tested in this research. While used as an outcome measure in Raina’s model, caregiver health is tested in terms of its association with caregiver demands because of the long term impact of caregivers’ emotional and physical health on managing the demands of that role (Deatrick et al., 2009; Hardy et al., 2008; Raina et al., 2004). Less attention has been directed toward the caregiver’s perceived mastery or competence for actually managing these demands. Caregiver competence is correlated with care recipient outcomes in both adult brain tumor (Sherwood et al., 2007) and childhood chronic illness (Knafl et al., 2011) samples. In terms of caregivers, those who are less healthy (physically and psychologically) experience more demands, and similarly, those who experience more demands feel less competent (Boydell, Stasiulis, Greenberg, Greenberg, & Spiegler, 2008; Klassen et al., 2011; Sherwood et al., 2007). Thus, based on the model proposed for this research (shown in Figure 1), the following hypothesis was tested: better caregiver health, better survivor health, and better family functioning contribute directly to fewer caregiving demands, which in turn contribute to greater caregiver competence.