Barriers to Mental Health Care for Urban, Lower Income Families Referred from Pediatric Primary Care

  • Justine Larson
  • Susan dosReis
  • Miriam Stewart
  • Rochelle Kushner
  • Emily Frosch
  • Barry Solomon
Original Article

Abstract

The aim of this study was to evaluate the association of parent-reported barriers on the likelihood of attending a mental health evaluation after referral from pediatric primary care. As the part of procedure, parents of children (N = 55) referred for mental health from primary care completed a 23-item questionnaire (three subscales; Cronbach alpha > 0.7): intangible barriers, tangible barriers, and child functioning. Logistic regression examined associations between responses and referral follow-through. The results showed that the high levels of intangible barriers were associated with decreased odds of attending the mental health evaluation (OR = 0.20, 0.06–0.83; P = 0.03). Therefore, we conclude that parental concerns about mental health care may be important for engagement in treatment.

Keywords

Community mental health services Access to healthcare Pediatric Referrals and consultation 

References

  1. Bussing, R., Koro-Ljungberg, M. E., Gary, F., Mason, D. M., & Garvan, C. W. (2005). Exploring help-seeking for ADHD symptoms: A mixed-methods approach. Harvard Review of Psychiatry, 13(2), 85–101.PubMedCrossRefGoogle Scholar
  2. Bussing, R., Mills, T., & Garvan, C. (2007). Cultural variations in parental health beliefs, knowledge, and information sources related to ADHD. Journal of Family Issues, 28(3), 291–318.CrossRefGoogle Scholar
  3. Bussing, R., Schoenberg, N. E., & Perwien, A. R. (1998). Knowledge and information about ADHD: Evidence of cultural differences among african-american and white parents. Social Science and Medicine, 46(7), 919–928.PubMedCrossRefGoogle Scholar
  4. Bussing, R., Zima, B. T., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., et al. (2003). Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), 842–850.PubMedCrossRefGoogle Scholar
  5. Chacko, A., Wymbs, B. T., Wymbs, F. A., Pelham, W. E., Swanger-Gagne, M. S., Girio, E., et al. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child and Adolescent Psychology, 38(2), 206–218.PubMedCrossRefGoogle Scholar
  6. dosReis, S., Barksdale, C., Sherman, A., Maloney, K., & Charach, A. (2010). Stigmatizing experiences of parents of children newly diagnosed with ADHD. Psychiatric Services, 61(8), 811–816.PubMedCrossRefGoogle Scholar
  7. Eiraldi, R. B., Mazzuca, L. B., Clarke, A. T., & Power, T. J. (2006). Service utilization among ethnic minority children with ADHD: A model of help-seeking behavior. Administration and Policy in Mental Health, 33(5), 607–622.PubMedCrossRefGoogle Scholar
  8. Harrison, M. E., McKay, M. M., & Bannon, W. M., Jr. (2004). Inner-city child mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40(2), 119–131.PubMedCrossRefGoogle Scholar
  9. Hoberman, H. M. (1992). Ethnic minority status and adolescent mental health services utilization. Journal of Mental Health Administration, 19(3), 246–267.PubMedCrossRefGoogle Scholar
  10. Kataoka, S., Zhang, L., & Wells, K. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548.PubMedCrossRefGoogle Scholar
  11. Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to treatment participation scale: Evaluation and validation in the context of child outpatient treatment. Journal of Child Psychology and Psychiatry, 38(8), 1051–1062.PubMedCrossRefGoogle Scholar
  12. Kelleher, K. J., Campo, J. V., & Gardner, W. P. (2006). Management of pediatric mental disorders in primary care: Where are we now and where are we going? Current Opinion in Pediatrics, 18(6), 649–653.PubMedCrossRefGoogle Scholar
  13. Lang, T. A., & Secic, M. (2006). How to report statistics in medicine: Annotated guidelines for authors, editors, and reviewers (2nd ed.). Philadelphia: American College of Physicians.Google Scholar
  14. Lavigne, J. V., Arend, R., Rosenbaum, D., Binns, H. J., Christoffel, K. K., Burns, A., et al. (1998). Mental health service use among young children receiving pediatric primary care. Journal of the American Academy of Child and Adolescent Psychiatry, 37(11), 1175–1183.PubMedCrossRefGoogle Scholar
  15. Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, C. W., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Methods for the epidemiology of child and adolescent mental disorders study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889–897.PubMedCrossRefGoogle Scholar
  16. Nock, M. K., Ferriter, C., & Holmberg, E. (2007). Parent beliefs about treatment credibility and effectiveness: Assessment and relation to subsequent treatment participation. Journal of Child and Family Studies, 16, 27–38.CrossRefGoogle Scholar
  17. Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73(5), 872–879.PubMedCrossRefGoogle Scholar
  18. Olafsdottir, S., & Pescosolido, B. A. (2009). Drawing the line: The cultural cartography of utilization recommendations for mental health problems. Journal of Health and Social Behavior, 50(2), 228–244.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. Pescosolido, B. A., Jensen, P. S., Martin, J. K., Perry, B. L., Olafsdottir, S., & Fettes, D. (2008a). Public knowledge and assessment of child mental health problems: Findings from the national stigma study-children. Journal of the American Academy of Child and Adolescent Psychiatry, 47(3), 339–349.PubMedCrossRefGoogle Scholar
  21. Pescosolido, B. A., Martin, J. K., Lang, A., & Olafsdottir, S. (2008b). Rethinking theoretical approaches to stigma: A framework integrating normative influences on stigma (FINIS). Social Science & Medicine, 67(3), 431–440.CrossRefGoogle Scholar
  22. Rushton, J., Bruckman, D., & Kelleher, K. (2002). Primary care referral of children with psychosocial problems. Archives of Pediatrics and Adolescent Medicine, 156(6), 592–598.PubMedGoogle Scholar
  23. Sayal, K., Goodman, R., & Ford, T. (2006). Barriers to the identification of children with attention deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 47(7), 744–750.PubMedCrossRefGoogle Scholar
  24. U.S. Public Health Service. (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda.Google Scholar
  25. Walders, N., Childs, G. E., Comer, D., Kelleher, K. J., & Drotar, D. (2003). Barriers to mental health referral from pediatric primary care settings. American Journal of Managed Care, 9(10), 677–683.PubMedGoogle Scholar
  26. Yeh, M., Hough, R. L., McCabe, K., Lau, A., & Garland, A. (2004). Parental beliefs about the causes of child problems: Exploring racial/ethnic patterns. Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 605–612.PubMedCrossRefGoogle Scholar
  27. Yeh, M., McCabe, K., Hough, R. L., Lau, A., Fakhry, F., & Garland, A. (2005). Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use. Journal of Consulting and Clinical Psychology, 73(5), 800–807.PubMedCrossRefGoogle Scholar
  28. Zito, J. M., Safer, D. J., Riddle, M. A., Johnson, R. E., Speedie, S. M., & Fox, M. (1998). Prevalence variations in psychotropic treatment of children. Journal of Child and Adolescent Psychopharmacology, 8(2), 99–105.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Justine Larson
    • 1
    • 2
  • Susan dosReis
    • 3
  • Miriam Stewart
    • 4
  • Rochelle Kushner
    • 5
  • Emily Frosch
    • 1
  • Barry Solomon
    • 6
  1. 1.Division of Child and Adolescent PsychiatryJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Arlington County Department of Human ServicesArlingtonUSA
  3. 3.Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreUSA
  4. 4.Johns Hopkins School of MedicineBaltimoreUSA
  5. 5.Tufts University School of MedicineBostonUSA
  6. 6.Division of General Pediatrics and Adolescent MedicineJohns Hopkins School of MedicineBaltimoreUSA

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