Skip to main content

Advertisement

SpringerLink
Log in

Individual, Family, and Site Predictors of Youth Receipt of Therapy in Systems of Care

  • Original Paper
  • Published:
Child & Youth Care Forum Aims and scope Submit manuscript

Abstract

Background

The majority of youth with mental health needs do not receive therapy services to treat their disorder, and unmet need is particularly high among racial and ethnic minorities and economically disadvantaged families in the population at large. Investigating whether these patterns emerge within systems of care can reveal opportunities to expand therapy access and utilization.

Objective

This study examines multilevel predictors of receipt of therapy within the Children’s Mental Health Initiative (CMHI), the largest federally-funded effort in the United States to serve youth with significant emotional or behavioral disturbance, to determine whether disparities in therapy use persist within this specialized population that has been connected to a service array.

Method

Using data from 1604 youth aged 10–17 in 33 CMHI-funded system of care sites, the relationship between youth, family and site-level variables and the receipt of outpatient therapy in the first 6 months of service were examined using a multilevel model.

Results

Youth who were African American, had caregivers with less education, were in families at or below the poverty level, or lived in sites that served a higher rate of families below the poverty level were less likely to receive needed therapy services after controlling for age, gender, and symptomatology.

Conclusions

Despite the CMHI’s success in connecting the majority of enrolled youth to therapy services, treatment disparities persist along racial and socioeconomic lines. These findings identify youth and communities that may require additional strategies and attention to better connect youth to needed therapy services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist 14–18 and 1991 profile. Burlington, VT: University Associates in Psychiatry.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school—Age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth and Families.

    Google Scholar 

  • American Psychological Association. (2014). Demographic characteristics of APA members by membership status, 2014. Retrieved May 15, 2018 from http://www.apa.org/workforce/publications/14-member/table-1.pdf.

  • Angold, A., Messer, S. C., Stangl, D., Farmer, E. M. Z., Costello, E. J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88(1), 75–80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ascher, B. H., Z. Farmer, E. M., Burns, B. J., & Angold, A. (1996). The child and adolescent services assessment (CASA): Description and psychometrics. Journal of Emotional and Behavioral Disorders, 4(1), 12–20.

    Article  Google Scholar 

  • Brannan, A. M., Brashears, F., Gyamfi, P., & Manteuffel, B. (2012). Implementation and development of federally-funded systems of care over time. American Journal of Community Psychology, 49(3–4), 467–482.

    Article  PubMed  Google Scholar 

  • Bridge, J. A., Asti, L., Horowitz, L. M., Greenhouse, J. B., Fontanella, C. A., Sheftall, A. H., et al. (2015). Suicide trends among elementary school–aged children in the United States from 1993 to 2012. JAMA Pediatrics, 169, 673–677.

    Article  PubMed  Google Scholar 

  • Burnett-Zeigler, I., & Lyons, J. S. (2010). Caregiver factors predicting service utilization among youth participating in a school-based mental health intervention. Journal of Child and Family Studies, 19(5), 572–578.

    Article  Google Scholar 

  • Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., et al. (1995). Children’s mental health service use across service sectors. Health Affairs (Project Hope), 14(3), 147–159.

    Article  Google Scholar 

  • Cabral, R. R., & Smith, T. B. (2011). Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58(4), 537–554.

    Article  PubMed  Google Scholar 

  • Caldwell, J. T., Ford, C. L., Wallace, S. P., Wang, M. C., & Takahashi, L. M. (2017). Racial and ethnic residential segregation and access to health care in rural areas. Health & Place, 43, 104–112.

    Article  Google Scholar 

  • Canvin, K., Jones, C., Marttila, A., Burstrom, B., & Whitehead, M. (2007). Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: Qualitative study. Journal of Epidemiology and Community Health, 61(11), 984–989.

    Article  PubMed  PubMed Central  Google Scholar 

  • Center for Mental Health Services. (2004). Mental health, United States, 2004. In R. W. Manderscheid & J. T. Berry (Eds.), DHHS Publication No. (SMA) 06-4195. Rockville, MD: Substance Abuse and Mental Health Services Administration.

    Google Scholar 

  • Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). (2016). The comprehensive community mental health services for children with serious emotional disturbances program. Report to Congress, 2016.

  • Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., et al. (2011). Evidence-based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18(2), 154–172.

    Google Scholar 

  • Chow, J., Jaffe, K., & Snowden, L. R. (2003). Mental health service use by racial and ethnic populations in poverty areas. American Journal of Public Health, 93, 792–797.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, P., & Hesselbart, C. S. (1993). Demographic factors in the use of children’s mental health services. American Journal of Public Health, 83(1), 49–52.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cooper-Patrick, L., Powe, N. R., Jenckes, M. W., Gonzales, J. J., Levine, D. M., & Ford, D. E. (1997). Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine, 12(7), 431–438.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cunningham, P. J., & Freiman, M. (1996). Determinants of ambulatory mental health services use for school-age children and adolescents. Health Services Research, 31(4), 409–427.

    PubMed  PubMed Central  Google Scholar 

  • Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: Patterns of care for children’s mental health across one year. Community Mental Health Journal, 35(1), 31–46.

    Article  PubMed  Google Scholar 

  • Flisher, A. J., Kramer, R. A., Grosser, R. C., Alegria, M., Bird, H. R., Bourdon, K. H., et al. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27(5), 1145–1154.

    Article  PubMed  Google Scholar 

  • Friedman, R. M., & Hernandez, M. (2002). The national evaluation of the comprehensive community mental health services for children and their families program: A commentary. Children’s Services, 5(1), 67–74.

    Article  Google Scholar 

  • 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. The American Journal of Psychiatry, 162(7), 1336–1343.

    Article  PubMed  Google Scholar 

  • Graves, K. N., Shelton, T. L., & Kaslow, N. J. (2009). Utilization of individual versus family therapy among adolescents with severe emotional disturbance. American Journal of Family Therapy, 37, 227–238.

    Article  Google Scholar 

  • Gudiño, O. G., Lau, A. S., & Hough, R. L. (2008). Immigrant status, mental health need, and mental health service utilization among high-risk Hispanic and Asian Pacific Islander youth. Child & Youth Care Forum, 37(3), 139–152.

    Article  Google Scholar 

  • Gudiño, O. G., Lau, A. S., Yeh, M., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by problem type? Journal of Emotional and Behavioral Disorders, 17(1), 3–16.

    Article  Google Scholar 

  • Gyamfi, P. (2004). Children with serious emotional disturbance: The impact of poverty and receipt of public assistance on behavior, functioning, and service use. Children and Youth Services Review, 26, 1129–1139.

    Article  Google Scholar 

  • Haines, M. M., McMunn, A., Nazroo, J. Y., & Kelly, Y. J. (2002). Social and demographic predictors of parental consultation for child psychological difficulties. Journal of Public Health, 24(4), 276–284.

    Article  Google Scholar 

  • Hoagwood, K., Horwitz, S., Stiffman, A., Weisz, J., Bean, D., Rae, D., et al. (2000). Concordance between parent reports of children’s mental health services and service records: The services assessment for children and adolescents (SACA). Journal of Child and Family Studies, 9(3), 315–331.

    Article  Google Scholar 

  • Horwitz, S. M., Gary, L. C., Briggs-Gowan, M. J., & Carter, A. S. (2003). Do needs drive services use in young children? Pediatrics, 112(6 Pt 1), 1373–1378.

    Article  PubMed  Google Scholar 

  • Huang, L., Stroul, B., Friedman, R., Mrazek, P., Friesen, B., Pires, S., et al. (2005). Transforming mental health care for children and their families. American Psychologist, 60(6), 615–627.

    Article  PubMed  Google Scholar 

  • Hurlburt, M. S., Leslie, L. K., Landsverk, J., Barth, R. P., Burns, B. J., Gibbons, R. D., et al. (2004). Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry, 61(12), 1217.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, W. C., LaForest, M., Lissenden, B., & Stern, S. (2017). Variation in mental illness and provision of public mental health services. Health Services and Outcomes Research Methodology, 17(1), 1–30.

    Article  Google Scholar 

  • Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.

    Article  PubMed  Google Scholar 

  • Katapodi, M. C., Pierce, P. F., & Facione, N. C. (2010). Distrust, predisposition to use health services and breast cancer screening: Results from a multicultural community-based survey. International Journal of Nursing Studies, 47(8), 975–983.

    Article  PubMed  Google Scholar 

  • Kirby, J. B., & Kaneda, T. (2005). Neighborhood socioeconomic disadvantage and access to health care. Journal of Health and Social Behavior, 46(1), 15–31.

    Article  PubMed  Google Scholar 

  • Lilienfeld, S. O., Ammirati, R., & David, M. (2012). Distinguishing science from pseudoscience in school psychology: Science and scientific thinking as safeguards against human error. Journal of School Psychology, 50(1), 7–36.

    Article  PubMed  Google Scholar 

  • Lindsey, M. A., Brown, D. R., & Cunningham, M. (2017). Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal of Orthopsychiatry, 87(4), 377.

    Article  PubMed  Google Scholar 

  • Litaker, D., Koroukian, S. M., & Love, T. E. (2005). Context and healthcare access: Looking beyond the individual. Medical Care, 43(6), 531–540.

    Article  PubMed  Google Scholar 

  • McGuire, T. G., Alegria, M., Cook, B. L., Wells, K. B., & Zaslavsky, A. M. (2006). Implementing the Institute of Medicine definition of disparities: an application to mental health care. Health Services Research, 41(5), 1979–2005.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merikangas, K. R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U. S. adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45.

    Article  PubMed  Google Scholar 

  • Miech, R., Azur, M., Dusablon, T., Jowers, K., Goldstein, A., Stuart, E., et al. (2008). The potential to reduce mental health disparities through the comprehensive community mental health services for children and their families program. Journal of Behavioral Health Services & Research, 35(3), 253–264.

    Article  Google Scholar 

  • Pina, A. A., Polo, A. J., & Huey, S. J. (2019). Evidence-based psychosocial interventions for ethnic minority youth: The 10-year update. Journal of Clinical Child & Adolescent Psychology, 48(2), 1–24.

    Article  Google Scholar 

  • Popescu, I., Xu, H., Krivelyova, A., & Ettner, S. (2015). Disparities in receipt of specialty services among children with mental health need enrolled in the CMHI. Psychiatric Services, 66(3), 242–248.

    Article  PubMed  Google Scholar 

  • Porterfield, S. L., & McBride, T. D. (2007). The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs. American Journal of Public Health, 97(2), 323–329.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pottick, K. J., Bilder, S., Vander Stoep, A., Warner, L. A., & Alvarez, M. F. (2007). US patterns of mental health service utilization for transition-age youth and young adults. Journal of Behavioral Health Services and Research, 35(4), 373–389.

    Article  PubMed  Google Scholar 

  • Probst, J. C., Moore, C. G., Glover, S. H., & Samuels, M. E. (2004). Person and place: The compounding effects of race/ethnicity and rurality on health. American Journal of Public Health, 94(10), 1695–1703.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sanchez, T. W. (2008). Poverty, policy, and public transportation. Transportation Research Part A: Policy and Practice, 42(5), 833–841.

    Google Scholar 

  • Shirk, S. R. (2001). The road to effective child psychological services: Treatment processes and outcome research. In J. H. Hughes, A. M. LaGreca, & J. C. Conoley (Eds.), Handbook of psychological services for children and adolescents (pp. 43–59). New York: Oxford University Press.

    Chapter  Google Scholar 

  • Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.

    Google Scholar 

  • Smith, T. B., Constantine, M. G., Dunn, T. W., Dinehart, J. M., & Montoya, J. A. (2006). Multicultural education in the mental health professions: A meta-analytic review. Journal of Counseling Psychology, 53(1), 132–145.

    Article  Google Scholar 

  • Snowden, L. R., & Thomas, K. (2000). Medicaid and African American outpatient mental health treatment. Mental Health Services Research, 2(2), 115–120.

    Article  PubMed  Google Scholar 

  • Snowden, L. R., & Yamada, A. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166.

    Article  PubMed  Google Scholar 

  • Stroul, B., & Friedman, R. (1986, revised edition). A system of care for severely emotionally disturbed children and youth. Washington, DC: CASSP Technical Assistance Center.

  • Syed, S., Gerber, B., & Sharp, L. (2013). Traveling towards disease: Transportation barriers to health care access. Journal of Community Health, 38(5), 976–993.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323–1328.

    Article  PubMed  Google Scholar 

  • Thompson, R. (2005). The course and correlates of mental health care received by young children: Descriptive data from a longitudinal urban high-risk sample. Children and Youth Services Review, 27(1), 39–50.

    Article  Google Scholar 

  • Thompson, R., & May, M. A. (2006). Caregivers’ perceptions of child mental health needs and service utilization: An urban 8-year old sample. Journal of Behavioral Health Services and Research, 33(4), 474–482.

    Article  PubMed  Google Scholar 

  • Verhulst, F., & van der Ende, J. (1997). Factors associated with child mental health service use in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 901–909.

    Article  PubMed  Google Scholar 

  • Vinson, N. B., Brannan, A. M., Baughman, L. N., Wilce, M., & Gawron, T. (2001). The system-of-care model: Implementation in twenty-seven communities. Journal of Emotional and Behavioral Disorders, 9(1), 30–42.

    Article  Google Scholar 

  • Weisz, J. R., & Hawley, K. M. (1998). Finding, evaluating, refining, and applying empirically supported treatments for children and adolescents. Journal of Clinical Child Psychology, 27, 206–216.

    Article  PubMed  Google Scholar 

  • Youngstrom, E., Loeber, R., & Stouthamer-Loeber, M. (2000). Patterns and correlates of agreement between parent, teacher, and male adolescent ratings of externalizing and internalizing problems. Journal of Consulting and Clinical Psychology, 68(6), 1038–1050.

    Article  PubMed  Google Scholar 

  • Zaboski, B. A., Schrack, A. P., Joyce-Beaulieu, D., & MacInnes, J. W. (2017). Broadening our understanding of evidence-based practice: Effective and discredited interventions. Contemporary School Psychology, 21(3), 287–297.

    Article  Google Scholar 

  • Zimmerman, F. J. (2005). Social and economic determinants of disparities in professional help-seeking for child mental health problems: Evidence from a national sample. Health Services Research, 40(5I), 1514–1533.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by a subcontract to a cooperative agreement between the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Illinois Department of Health Services (IDHS). The conclusions are solely the responsibility of the authors and do not necessarily represent the official views of either IDHS or SAMHSA.

Author information

Authors and Affiliations

  1. University of Illinois at Urbana-Champaign, 603 East Daniel St., Champaign, IL, 61820, USA

    Jessica J. Fitts, Mark S. Aber & Nicole E. Allen

Authors
  1. Jessica J. Fitts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark S. Aber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicole E. Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica J. Fitts.

Ethics declarations

Conflict of interest

Authors Aber and Allen have received SAMHSA funding, through the Illinois Department of Human Services Division of Mental Health, to conduct evaluation of a local system of care initiative (State-assigned Grant #D7333). Author Fitts declares that she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Thank you to Kirstin Painter, Ph.D., Public Health Analyst at the Center for Mental Health Services (SAMHSA) for her assistance with accessing the CMHI data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fitts, J.J., Aber, M.S. & Allen, N.E. Individual, Family, and Site Predictors of Youth Receipt of Therapy in Systems of Care. Child Youth Care Forum 48, 737–755 (2019). https://doi.org/10.1007/s10566-019-09504-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10566-019-09504-w

Keywords

Search

Navigation