Community Mental Health Journal

, Volume 40, Issue 2, pp 119–131 | Cite as

Inner-City Child Mental Health Service Use: The Real Question Is Why Youth and Families Do Not Use Services

  • Myla E. Harrison
  • Mary M. McKay
  • William M. BannonJr.
Article

Abstract

Objective: This study examines pathways to urban child mental health care as well as explores reasons why care was not received. Methods: A single group longitudinal design was used to study initial attendance rates at an outpatient child mental health clinic and identify factors associated with initial service use for urban children and their families. Results: Approximately one-third of families (n = 82) do not follow up with care despite their child being referred and an initial appointment scheduled. Yet, three-quarters of those who did not attend a first session still wanted services when interviewed. Factors most significantly related to service use were social support and parental skill efficacy. Miscommunication between adult caregiver and provider was the most often cited reason for non-attendance. Conclusions: There is a significant unmet need for care along with identification of significant barriers to access. Empirical findings can serve as the basis for modifying urban child mental health service delivery systems.

children's mental health mental health service utilization urban mental health 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Aday, L. A. (1993). Indicators and predictors of health services utilization, in Introduction to Health Services, 4th ed, pp. 46-67. Williams S. J. and Torrens P. R. (Eds.). Albany, NY: Delmar Publishers Inc.Google Scholar
  2. Armbruster, P. & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic. American Journal of Orthopsychiatry, 64, 577-585.Google Scholar
  3. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. 2nd. (2002). Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care. Public Health Report, 118, 293-302.Google Scholar
  4. Buckner, J. C. & Bassuk, E. L. (1997). Mental disorders and service utilization among youths from homeless and low-income housed families. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 890-900.Google Scholar
  5. Burchard, J. D., Bruns, E. J., & Burchard S. N. (2002). The Wraparound Approach. In Burns, B. J. and Hoagwood, K. (Eds.). Community Treatment for Youthand Behavioral Disorders (pp. 69-90), New York: Oxford University Press.Google Scholar
  6. Burns, B. J. (2002). Reasons for Hope for Children and Families: A Perspective and Overview. In Burns, B. J. and Hoagwood, K. (Eds.). Community Treatment for Youth, Evidence-Based Interventions for Severe Emotional and Behavioral Disorders (pp. 3-15), New York: Oxford University Press.Google Scholar
  7. Burns, B. J., Angold, A., Magruder-Habib, K., Costello, E. J., & Patrick, M. K. S. (1994). The Child and Adolescent Services Assessment (CASA), Parent Interview and Child Interview. Durham, NC, Developmental Epidemiology Program, Department of Psychiatry, Duke University Medical Center.Google Scholar
  8. Cauce, A. M., Domenech-Rodriguez, M., Paradise M., Cochran, B. N., Shea J. M., Srebnik, D., & Baydar N. (2002). Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70, 44-55.Google Scholar
  9. Cornelius, J. R., Pringle, J., Jernigan, J., Kirisci, L., & Clark, D. B. (2001). Correlates of mental health service utilization and unmet need among a sample of male adolescents. Addictive Behaviors, 25, 11-19.Google Scholar
  10. Dakof, G. A., Tejeda, M., & Liddle H. A. (2001). Predictors of engagement in adolescent drug abuse treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 274-281.Google Scholar
  11. Duchnowski, A. J., Kutash, K., & Friedman, R. M. (2002). Community-Based Interventions in a System of Care and Outcomes Framework. In Burns, B. J. and Hoagwood, K. (Eds.). In Community Treatment for Youth, Evidence-Based Interventions for Severe Emotional and Behavioral Disorders (pp. 16-37). New York: Oxford University Press.Google Scholar
  12. Dumas, J. E. & Wahler, R. G. (1983). Predictors of treatment outcome in parent training: Mother insularity and socioeconomic disadvantage. Behavioral Assessment, 5, 301-313.Google Scholar
  13. Farmer, E. M., Angold, A., Burns, B. J., & Costello E. J. (1994). Reliability of self-reported service use: test-retest consistency of children's responses to Child and Adolescent Services Assessment (CASA). Journal of Child and Family Studies, 3, 307-325.Google Scholar
  14. Flisher, A. J., Kramer, R. A., Grosser, R. C., Alegria, M., Bird, H. R., Bourdon, S. H., Goodman, S. H., Greenwald S., Horwitz, S. M., Moore, R. E., Narrow, W. E., & Hoven, C. W. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27, 1145-1154.Google Scholar
  15. Goyette, C., Conners, C., & Ulrich, R. (1978). Normative data on revised Conners Parent and Teacher Rating Scales. Journal of Abnormal Child Psychology, 6, 221-236.Google Scholar
  16. Griffin, J. A., Cicchetti, D., & Leaf, P. J. (1993). Characteristics of youths identified from a psychiatric case register as first-time users of services. Hospital and Community Psychiatry, 44, 62-65.Google Scholar
  17. Hoberman, H. M. (1992). Ethnic minority status and adolescent mental health services utilization. The Journal of Mental Health Administration, 19, 246-267.Google Scholar
  18. Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65, 453-463.Google Scholar
  19. Kazdin, A. E., Mazurick, J. L., & Bass, D. (1993). Risk for attrition in treatment of antisocial children and families. Journal of Clinical Child Psychology, 22, 2-16.Google Scholar
  20. Kazdin, A. E., Mazurick, J. L., & Siegel, T. C. (1994). Treatment outcome among children with externalizing disorder who terminate prematurely versus those who complete psychotherapy. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 549-557.Google Scholar
  21. 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.Google Scholar
  22. Kellam, S. G., Branch, J. D., Agrawal, K. C., & Ensminger, M. E. (1975). Mental Health and Going to School. The Woodlawn Program of Assessment, Early Intervention and Evaluation. Chicago, University of Chicago Press.Google Scholar
  23. Koroloff, N. M., Elliot, D. J., Koren, P. E., & Friesen, B. J. (1994). Connecting Low-Income Families to Mental Health Services: The Role of the Family Associate. Journal of Emotional and Behavioral Disorders, 2, 240-246.Google Scholar
  24. Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, C. W., Narrow, W. E., Vaden-Kiernan, M., & Regier, D. A. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 889-897.Google Scholar
  25. McKay, M. M., Stoewe, J., & McCadam, K., Gonzales, J. (1998). Increasing access to child mental health services for urban children and their caregivers. Health and Social Work, 23, 9-15.Google Scholar
  26. McMiller, W. P. & Weisz, J. R. (1996). Help-seeking preceding mental health clinic intake among African-American, Latino, and Caucasian youths. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1086-1094.Google Scholar
  27. Morrissey-Kane, E., Prinz, R. J. (1999). Engagement in child and adolescent treatment: the role of parental cognitions and attributions. Clinical Child and Family Psychology Review, 2, 183-198.Google Scholar
  28. Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., & Ialongo, N. S. (2002). Barriers to children's mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 731-738.Google Scholar
  29. Pearson, J. L., Hunter, A. G., Ensminger, M. E., &Kellam, S. G. (1990). Black grandmothers in multigenerational households: Diversity in family structure and parenting involvement in the Woodlawn community. Child Development, 61, 434-442.Google Scholar
  30. Ramsey, E. & Walker, H. (1988). Family management connection with antisocial behavior among middle school boys. Behavioral Disorders pp. 187-201.Google Scholar
  31. Rosenblatt, A. & Woodbridge, M. W. (2003). Deconstructing research on systems of care for youth with EBD (emotional and behavioral disturbance): Frameworks for policy research. Journal of Emotional and Behavioral Disorders, 11, 27-37.Google Scholar
  32. Saunders, S. M., Resnick, M. D., Hoberman, H. M., & Blum, R. W. (1994). Formal help-seeking behavior of adolescents identifying themselves as having mental health problems. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 718-728.Google Scholar
  33. Schwab-Stone, M., Ruchkin, V., Vermeiren, R., & Leckman, P. (2001). Cultural considerations in the treatment of children and adolescents. Operationalizing the importance of culture in treatment. Child and Adolescent Psychiatric Clinics of North America, 10, 729-743.Google Scholar
  34. Snowden, L. R. (1998). Racial differences in informal help seeking for mental health problems. Journal of Community Psychology, 26, 429-438.Google Scholar
  35. Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3, 181-187.Google Scholar
  36. Staudt, M. (1999). Barriers and facilitators to use of services following intensive family preservation services. The Journal of Behavioral Health Services & Research, 26, 39-49.Google Scholar
  37. Staudt, M. M. (2003). Helping Children Access and Use Services: A Review. Journal of Child and Family Studies, 12, 49-60.Google Scholar
  38. Tharp, R. G. (1991). Cultural diversity and the treatment of children. Journal of Consulting and Clinical Psychology, 59, 799-812.Google Scholar
  39. Tolan, P. H. & Gorman-Smith, D. (1991). Metropolitan Area Child Study Parent Questionnaire. University of Illinois at Chicago.Google Scholar
  40. U. S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General, Rockville, MD: U. S. DHHS, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.Google Scholar
  41. Wahler, R. & Dumas, J. (1989). Attentional problems in dysfunctional mother-child interactions: An interbehavior model. Psychological Bulletin 105, 116-130.Google Scholar
  42. Webster-Stratton, C. (1985). Case studies and clinical replication series—predictors of treatment outcome in parent training for conduct disordered children. Behavior Therapy, 16, 223-243.Google Scholar
  43. Zahner, G. E. P., Pawelkiewicz, W., DeFrancesco, J. J., & Adnopoz, J. (1992). Children's mental health service needs and utilization patterns in an urban community: an epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 951-960.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2004

Authors and Affiliations

  • Myla E. Harrison
    • 1
  • Mary M. McKay
    • 2
  • William M. BannonJr.
    • 2
  1. 1.Department of PsychiatryMount Sinai School of MedicineNew York
  2. 2.Mount Sinai School of MedicineUSA

Personalised recommendations