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Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

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Abstract

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.

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References

  • Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Anderson, E. (1999). Code of the street: Decency, violence and the moral life of the inner city. New York: W.W. Norton and Company.

    Google Scholar 

  • Atkins, M. S., Graczyk, P. A., Frazier, S. L., & Abdul-Adil, J. (2003). Toward a new model for promoting urban children’s mental health: Accessible, effective, and sustainable school-based mental health services. School Psychology Review, 32(4), 503–514.

    Google Scholar 

  • Bandura, A. (1975). Social learning and personality development. Holt, Rinehart & Winston, INC: New Jersey.

  • Blank, M., Mahmood, M., Fox, J., & Guterbock, T. (2002). Alternative mental health services: The role of the black church in the south. American Journal of Public Health, 92, 1668–1672.

    Article  PubMed  Google Scholar 

  • Breitkopf, C., Catero, J., Jaccard, J., & Berenson, A. (2004). Psychological and sociocultural perspectives on follow-up of abnormal papanicolaou results. Obstetrics and Gynecology, 104, 1347–1354.

    Article  PubMed  Google Scholar 

  • Breland-Noble, A. M. (2004). Mental healthcare disparities affect treatment of Black adolescents. Psychiatric Annals, 34, 534–541.

    PubMed  Google Scholar 

  • Breland-Noble, A. M. (2012). Community and treatment engagement for depressed African American youth: The AAKOMA FLOA pilot. Journal of Clinical Psychology in Medical Settings, 19(1), 41–48.

    Article  PubMed  Google Scholar 

  • Breland-Noble, A. M., & Weller, B. (Online First). Examining African American adolescent depression in a community sample: The impact of parent/child agreement. Journal of Child and Family Studies.

  • Breland-Noble, A. M., Burriss, A., Bell, C. C., & The AAKOMA Project Adult Advisory Board (2011). “Mama just won’t accept this”: Adult perspectives on engaging depressed African American Teens in clinical research and treatment. Journal of Clinical Psychology in Medical Settings, 18, (3), 225–234. doi:10.1007/s10880-011-92356.

    Google Scholar 

  • Breland-Noble, A. M., Bell, C., & Nicolas, G. (2006). Family first: The development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents. Fam Proc, 45, 153–169.

    Article  Google Scholar 

  • Brelenad-Noble, A. M., Burris, A., & Poole, H. K. (2010). Engaging depressed African American adolescents in treatment: Lessons from the AAKOMA project. Journal of Clinical Psychology: In Session, 68(8), 868–879.

    Article  Google Scholar 

  • Brown, L. K., Tolou-Shams, M., Lescano, C., Houck, C., Zeidman, J. Pugatch, D., Oourie, K. J., & Project SHIELD Study Group. (2006). Depressive symptoms as a predictor of sexual risk among African American adolescents and young adults. Journal of Adolescent Health, 39, e1–e8.

  • Bruns, E. J., Walrath, C., Glass-Siegel, M., & Weist, M. D. (2004). Association with school climate and special education referrals. Behavior Modification, 28, 491–512. doi:10.1177/0145445503259524.

    Article  PubMed  Google Scholar 

  • Burns, B. J., & Hoagwood, K. (2004). Evidence-based practice, Part I: Research update. Child and Adolescent Psychiatric Clinics of North America, 13, xi–xiii.

  • Cappella, E., Jackson, D. R., Bilal, C., Hamre, B. K., & Soulé, C. (2011). Bridging mental health and education in urban elementary schools: Participatory research to inform intervention development. School Psychology Review, 40(4), 486–508.

    Google Scholar 

  • Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., et al. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44. doi:10.1037/0022-006X.70.1.44.

    Article  PubMed  Google Scholar 

  • Chatters, L. M., Mattis, J. S., Woodward, A. T., Taylor, R. J., Neighbors, H. W., & Grayman, N. A. (2011). Use of ministers for a serious personal problem among African Americans: Findings from the national survey of American life. American Journal of Orthopsychiatry, 81(1), 118–127. doi:10.1111/j.1939-0025.2010.01079.x.

    Article  PubMed  Google Scholar 

  • Chow, G. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities use of mental health services in poverty areas. American Journal of Public Health, 93, 792–797.

    Article  PubMed  Google Scholar 

  • Cooley-Quille, M., Boyd, R. C., Frantz, E., & Walsh, J. (2001). Emotional and behavioral impact of exposure to community violence in inner-city adolescents. Journal of Clinical Child Psychology, 30, 199–206.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Pescosolido, B. A., Angold, A., & Burns, B. J. (1998). A family network-based model of access to child mental health services. Research in Community and Mental Health, 9, 165–190.

    Google Scholar 

  • dosReis, S., Mychailyszyn, M. P., Myers, M., & Riley, A. W. (2007). Coming to terms with ADHD: How urban African-American families come to seek care for their children. Psychiatric Services, 58, 636–641.

    Article  PubMed  Google Scholar 

  • Evans, S. W. (1999). Mental health services in schools: Utilization, effectiveness and consent. Clinical Psychology Review, 19, 165–178.

    Article  PubMed  Google Scholar 

  • Farmer, E. M. Z., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54, 60–66.

    Article  PubMed  Google Scholar 

  • Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.

    Google Scholar 

  • Fishbein, M., Trandis, H., Kanfer, F., Becker, M., Middlestadt, S., & Eichler, A. (2001). Factors influencing behavior and behavior change. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology. Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., & Teich, J. (2005). School mental health services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05-4068. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

  • Garland, A. F., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L., & Landsverk, J. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162, 1336–1343.

    Article  PubMed  Google Scholar 

  • Glied, S. P., & Daniel, S. (2002). Consequences and correlates of adolescent depression. Archives Pediatric Adolescent Medicine, 156, 1009–1014.

    Google Scholar 

  • Guilamo-Ramos, V., Jaccard, J., Dittus, P., Gonzalez, B., & Bouris, A. (2008). A conceptual framework for the analysis of risk and problem behaviors: The case of adolescent sexual behavior. Social Work Research, 32(1), 30–45.

    Article  Google Scholar 

  • Hoagwood, K. E., & Burns, B. J. (2005). Evidence-based practice, part II: Effecting change. Child and Adolescent Psychiatric Clinics of North America, 14, xv–xvii.

  • Hoagwood, K. E., Olin, S. S., Kerker, B. D., Kratochwill, T. R., Crowe, M., & Saka, N. (2007). Empirically based school interventions targeted at academic and mental health functioning. Journal of Emotional and Behavioral Disorders, 15, 66–92.

    Article  Google Scholar 

  • Husky, M. M., Kaplan, A., McGuire, L., Flynn, L., Chrostowski, C., & Olfson, M. (2011). Identifying adolescents at risk through voluntary school-base mental health screening. Journal of Adolescents, 34, 505–511.

    Article  Google Scholar 

  • Jaccard, J., Dodge, T., & Dittus, P. (2002). Parent-adolescent communication about sex and birth control: A conceptual framework. In S. Feldman, & D. A. Rosenthal (Eds.), Talking sexuality: Parent-adolescent communication. New Directions in Child and Adolescent Development. Series Editor W. Damon. San Francisco: Jossey-Bass.

  • Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quaterly, 11, 1–47.

    Article  Google Scholar 

  • Joe, S., Baser, R. S., Neighbors, H. W., Caldwell, C. H., & Jackson, J. S. (2009). 12-month and lifetime prevalence of suicide attempts among black adolescents in the national survey of American life. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 271–282.

    Article  PubMed  Google Scholar 

  • Kadivar, H., Garvie, P. A., Sinnock, C., Heston, J. D., & Flynn, P. M. (2006). Psychosocial profile of HIV-infected adolescents in a southern US urban cohort. AIDS Care, 18, 544–549.

    Article  PubMed  Google Scholar 

  • Kanfer, R. (1987). Task-specific motivation: An integrative approach to issues of measurement, mechanisms, processes, and determinants. Journal of Social and Clinical Psychology, 5, 237–264.

    Article  Google Scholar 

  • Kazdin, A. E. (2005). Evidence-based assessment for children and adolescents: Issues in measurement development and clinical application. Journal of Clinical Child and Adolescent Psychology, 34, 548–558.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Wassell, G. (2000). Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research, 2, 27–40.

    Article  PubMed  Google Scholar 

  • Kodjo, C. M., & Auinger, P. (2004). Predictors for emotionally distressed adolescents to receive mental health care. Journal of Adolescent Health, 35, 368.

    PubMed  Google Scholar 

  • Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage Publications, Inc.

    Google Scholar 

  • Lindsey, M. A. (2010). What are depressed African American adolescents males saying about mental health services and providers? In W. E. Johnson (Ed.), Social work with African American males—health, mental health, and social policy (pp. 161–178). New York, NY: Oxford University Press.

    Google Scholar 

  • Lindsey, M. A., Barksdale, C., Lambert, S. F., & Ialongo, N. (2010a). Social network influences on service use among urban, African American youth with mental health problems. Journal of Adolescent Health, 47(4), 367–373.

    Article  PubMed  Google Scholar 

  • Lindsey, M. A., Joe, S., & Nebbitt, V. (2010b). Family matters: The role of mental health stigma and social support on depressive symptoms and subsequent help seeking among African American boys. Journal of Black Psychology, 36, 458–482.

    Article  PubMed  Google Scholar 

  • Lindsey, M. A., Korr, W. S., Broitman, M., Bone, L., Green, A., & Leaf, P. J. (2006). Help-seeking behaviors and depression among African American adolescent boys. Social Work, 51, 49–58.

    Article  PubMed  Google Scholar 

  • Logan, D. E., & King, C. A. (2001). Parental facilitation of adolescent mental health services utilization: A conceptual and empirical review. Clinical Psychology: Science and Practice, 8(3), 319–333.

    Article  Google Scholar 

  • McKay, M., Nudelman, R., & McCadam, K. (1996). Involving inner-city families in mental health services: First interview engagement skills. Research on Social Work Practice, 6, 462–472.

    Article  Google Scholar 

  • Merikangas, K. R., He, J.-P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125, 75–81.

    Article  PubMed  Google Scholar 

  • Miles, M. B., & Huberman, A. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: SAGE Publications Ltd.

    Google Scholar 

  • Miller, W. L., & Crabtree, B. J. (1999). The dance of interpretation. In W. L. Miller & B. J. Crabtree (Eds.), Doing qualitative research (2nd ed., pp. 127–143). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.

    Google Scholar 

  • Mills, C., Stephan, S. H., Moore, E., Weist, M. D., Daly, B. P., & Edwards, M. (2006). The president’s new freedom commission: Capitalizing on opportunities to advance school-based mental health services. Clinical Child and Family Psychology Review, 9(3/4), 149–161.

    Article  PubMed  Google Scholar 

  • Molock, S. D., Barksdale, C., Matlin, S., Puri, R., Cammack, N., & Spann, M. (2007). Qualitative study of suicidality and help-seeking behaviors in African American adolescents. American Journal of Community Psychology, 40, 52–63. doi:10.1007/s10464-007-9122-3.

    Article  PubMed  Google Scholar 

  • Nabors, L. A., & Reynolds, M. W. (2000). Program evaluation activities: Outcomes related to treatment for adolescents receiving school-based mental health services. Children’s Services: Social Policy, Research, and Practice, 3, 175–189.

    Google Scholar 

  • Ofonedu, M., Percy, W., Harris-Britt, A., & Belcher, H. (2012) Depression in inner city African American youth: A phenomenological study. Journal of Child and Family Studies, 1–11. doi: 10.1007/s10826-012-9583-3.

  • Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41(6), 731–738.

    Article  PubMed  Google Scholar 

  • Randall, D. M., & Wolff, J. A. (1994). The time interval in the intention-behavior relationship: Meta-analysis. British Journal of Social Psychology, 33, 405–418.

    Article  Google Scholar 

  • Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3, 223–241.

    Article  PubMed  Google Scholar 

  • Rose, T., Joe, S., & Lindsey, M. (2011). Perceived stigma and depression among black adolescents in outpatient treatment. Children and Youth Services Review, 33, 161–166. doi:10.1016/j.childyouth.2010.08.029.

    Article  PubMed  Google Scholar 

  • Rosenstock, I. M., Stretcher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15, 175–183.

    Article  PubMed  Google Scholar 

  • Smetana, J. G., Campione-Barr, N., & Daddis, D. (2004). Longitudinal development of family decision making: Defining healthy behavioral autonomy for middle-class African American adolescents. Child Development, 75(5), 1418–1434.

    Article  PubMed  Google Scholar 

  • Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3, 181–187.

    Article  PubMed  Google Scholar 

  • Snowden, L. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93(2), 239–243.

    Article  PubMed  Google Scholar 

  • Snowden, L. R., & Yamada, A. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166. doi:10.1146/annurev.clinpsy.1.102803.143846.

    Article  PubMed  Google Scholar 

  • Stephan, S. H., Weist, M., Kataoka, S. H., Adelsheim, S., & Mills, C. (2007). Transformation of children’s mental health services: The role of school mental health. Psychiatric Services, 58, 1330–1338.

    Article  PubMed  Google Scholar 

  • Triandis, H. C., Vassiliou, V., Vassiliou, G., Tanaka, Y., & Shanmugam, A. V. (1972). The analysis of subjective culture. New York: Wiley.

    Google Scholar 

  • US Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—a supplement to mental health: A report of the surgeon general. Rockville, MD: Author.

    Google Scholar 

  • Vanderbleek, L. M. (2004). Engaging families in school-based mental health treatment. Journal Mental Health Counseling, 26, 211–224.

    Google Scholar 

  • Walrath, C., Bruns, E. J., Glass-Siegel, M., Anderson, K., & Weist, M. D. (2004). Understanding expanded school mental health services in Baltimore City. Behavior Modification, 28, 472–490.

    Article  PubMed  Google Scholar 

  • Webb, T., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132(2), 249–268.

    Article  PubMed  Google Scholar 

  • Weist, M. D., Myers, C. P., Hastings, E., Ghuman, H., & Han, Y. (1999). Psychosocial functioning of youth receiving mental health services in the schools vs. community mental health centers. Community Mental Health Journal, 35(5), 69–81.

    Article  PubMed  Google Scholar 

  • Williams, C. D., Lindsey, M., & Joe, S. (2011). Parent-adolescent concordance on perceived need for mental health services and its impact on service use. Children and Youth Services Review, 33, 2253–2260. doi:10.1016/j.childyouth.2011.07.011.

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr. Lindsey was supported for his time in preparation of this manuscript by the University of Maryland Multidisciplinary Research Career Development Program—MCRDP (NIH K12RR023250; PI: Alan R. Shuldiner). Dr. Lindsey was awarded a personal competitive 5-year K12 scholar career development award as allocated under the institutional MCRDP K12 grant awarded to the University of Maryland.

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Authors and Affiliations

  1. School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD, 21201, USA

    Michael A. Lindsey & Peggy Beall

  2. School of Medicine, Department of Psychiatry, University of Maryland, Baltimore, MD, 21201, USA

    Kerri Chambers & Alicia Lucksted

  3. School of Social Work, University of Southern California, Los Angeles, CA, 90089-0411, USA

    Cara Pohle

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  1. Michael A. Lindsey
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  2. Kerri Chambers
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  4. Peggy Beall
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Correspondence to Michael A. Lindsey.

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Lindsey, M.A., Chambers, K., Pohle, C. et al. Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives. J Child Fam Stud 22, 107–121 (2013). https://doi.org/10.1007/s10826-012-9668-z

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