Abstract
Residential treatment (RT) serves 311,000 children and adolescents per year and has been described as a “last resort” by families, healthcare providers, and insurance payors as it is highly disruptive and costly. The purpose of this study was to explore mothers' accounts of the strategies and services they used before admitting their adolescent to RT as well as to understand the barriers they encountered in their adolescent's treatment trajectory. This was a cross-sectional study in which 15 mothers of adolescents currently or previously in RT completed 1-h phone interviews. Data were analyzed using content analysis generating two themes and seven subthemes. The first theme, ‘the lead up to residential treatment,’ consists of descriptions of the treatment modalities before RT and mothers' initial impressions of RT. The second theme, "fighting tooth and nail," consists of descriptions of mothers’ actions to get their adolescent the mental health services they needed as well as the barriers they navigated along the way. While their adolescents were serious threats to themselves and others, mothers reported encountering significant obstacles to accessing RT, including substantial societal and financial barriers. While there is no shortage of evidence-based practices available that are effective in reducing disruptive behaviors in children, there are still macro-level implementation barriers that families are navigating to access mental health treatment for their child.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anclair, M., Lappalainen, R., Muotka, J., & Hiltunen, A. J. (2018). Cognitive behavioural therapy and mindfulness for stress and burnout: A waiting list controlled pilot study comparing treatments for parents of children with chronic conditions. Scandinavian Journal of Caring Sciences, 32(1), 389–396. https://doi.org/10.1111/scs.12473.
Baker, A. J. L., & Curtis, P. (2006). Prior placements of youth admitted to therapeutic foster care and residential treatment centers: The Odyssey project population. Child and Adolescent Social Work Journal, 23(1), 38–60. https://doi.org/10.1007/s10560-005-0031-8.
Blader, J. C., & Carlson, G. A. (2007). Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004. Biological Psychiatry, 62(2), 107–114. https://doi.org/10.1016/j.biopsych.2006.11.006.
Bourke-Taylor, H., Howie, L., Law, M., & Pallant, J. F. (2012). Self-reported mental health of mothers with a school-aged child with a disability in Victoria: A mixed method study. Journal of Paediatrics and Child Health, 48(2), 153–159. https://doi.org/10.1111/j.1440-1754.2011.02060.x.
Brown, J., Natzke, B., Ireys, H., Gillingham, M., & Hamilton, M. (2010). State variation in out-of-home Medicaid mental health services for children and youth: An examination of residential treatment and inpatient hospital services. Administration and Policy in Mental Health and Mental Health Services Research, 37(4), 318–326. https://doi.org/10.1007/s10488-009-0235-x.
Castilla-Puentes, R. (2008). Multiple episodes in children and adolescents with bipolar disorder: Comorbidity, hospitalization, and treatment (data from a cohort of 8,129 patients of a national managed care database). International Journal of Psychiatry in Medicine, 38(1), 61–70. https://doi.org/10.2190/PM.38.1.f.
Center for Behavioral Health Statistics and Quality. (2018). Results from the 2017 national survey on drug use and health: detailed tables, SAMHSA, CBHSQ. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.htm#lotsect11pe
Centers for Disease Control and Prevention. (2019). Data and statistics on children’s mental health. Centers for Disease Control and Prevention. http://cdc.gov/childrensmentalhealth/data.html.
Claudius, I. A., Donofrio, J. J., Lam, C. N., & Santillanes, G. (2014). Impact of boarding pediatric psychiatric patients on a medical ward. Hospital Pediatrics, 4(3), 125–132. https://doi.org/10.1542/hpeds.2013-0079.
Colalillo, S., & Johnston, C. (2016). Parenting cognition and affective outcomes following parent management training: A systematic review. Clinical Child and Family Psychology Review, 19(3), 216–235. https://doi.org/10.1007/s10567-016-0208-z.
Copeland, D. A., & Heilemann, M. V. (2008). Getting “to the point”: The experience of mothers getting assistance for their adult children who are violent and mentally ill. Nursing Research, 57(3), 136–143. https://doi.org/10.1097/01.NNR.0000319500.90240.d3.
DeRigne, L. (2010). What are the parent-reported reasons for unmet mental health needs in children? Health & Social Work, 35(1), 7–15. https://doi.org/10.1093/hsw/35.1.7.
Dozier, M., Kaufman, J., Kobak, R., O’Connor, T. G., Sagi-Schwartz, A., & Scott, S., et al. (2014). Consensus statement on group care for children and adolescents: A statement of policy of the American Orthopsychiatric Association. American Journal of Orthopsychiatry, 84(3), 219–225. https://doi.org/10.1037/ort0000005.
Faulkner, M., Gerlach, B., Marra, L., Gomez, R., & Schwab, J. (2014). SB 44 Needs Assessment: Examining the relinquishment of children with severe emotional disturbance. Austin, TX: The University of Texas at Austin, Child and Family Research Institute.
Findling, R. L., & Stepanova, E. (2018). The workforce shortage of child and adolescent psychiatrists: Is it time for a different approach? Journal of the American Academy of Child and Adolescent Psychiatry, 57(5), 300–301. https://doi.org/10.1016/j.jaac.2018.02.008.
Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last resort? A review of residential mental health placements for children and youth. Child and Youth Care Forum, 31(5), 307–339. https://doi.org/10.1023/A:1016826627406.
Fuller Torrey, E. (2016). A dearth of psychiatric beds. Psychiatric Times, 33(2).
Gould, S. R., Beals-Erickson, S. E., & Roberts, M. C. (2012). Gaps and barriers in services for children in state mental health plans. Journal of Child and Family Studies, 21(5), 767–774. https://doi.org/10.1007/s10826-011-9529-1.
Henry J. Kaiser Family Foundation. (2017). Next steps for CHIP: What is at stake for children? CA: Menlo Park.
Herbell, K., Banks, A. J., Bloom, T., Li, Y., & Bullock, L. F. C. (2020). Priorities for support in mothers of adolescents in residential treatment. Children and Youth Services Review, 110, 104805. https://doi.org/10.1016/j.childyouth.2020.104805.
Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687.
Huefner, J. C., Smith, G. L., Ringle, J. L., Stevens, A. L., Mason, W. A., & Parra, G. R. (2017). Patterns of psychotropic medication at admission for youth in residential care. Journal of Child and Family Studies, 26(1), 317–328. https://doi.org/10.1007/s10826-016-0548-9.
Izadi-Mazidi, M., Riahi, F., & Khajeddin, N. (2015). Effect of cognitive behavior group therapy on parenting stress in mothers of children with autism. Iranian Journal of Psychiatry and Behavioral Sciences, 9(3), e1900. https://doi.org/10.17795/ijpbs-1900.
Jozefiak, T., & Sønnichsen Kayed, N. (2015). Self- and proxy reports of quality of life among adolescents living in residential youth care compared to adolescents in the general population and mental health services. Health and Quality of Life Outcomes, 13(1), 104. https://doi.org/10.1186/s12955-015-0280-y.
La, E. M., Lich, K. H., Wells, R., Ellis, A. R., Swartz, M. S., Zhu, R., et al. (2015). Increasing access to state psychiatric hospital beds: Exploring supply-side solutions. Psychiatric Services, 67(5), 523–528. https://doi.org/10.1176/appi.ps.201400570.
Leonard, R. C., Franklin, M. E., Wetterneck, C. T., Riemann, B. C., Simpson, H. B., & Kinnear, K., et al. (2016). Residential treatment outcomes for adolescents with obsessive-compulsive disorder. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 26(6), 727–736. https://doi.org/10.1080/10503307.2015.1065022.
Lindell, K. U., Sorenson, C. K., & Mangold, S. V. (2020). The Family First Prevention Services Act: A New Era of Child Welfare Reform. Public Health Reports (Washington, D.C.: 1974). https://doi.org/10.1177/0033354919900892.
Looman, W. S., O’Conner-Von, S. K., Ferski, G. J., & Hildenbrand, D. A. (2009). Financial and employment problems in families of children with special health care needs: Implications for research and practice. Journal of Pediatric Health Care: Official Publication of National Association of Pediatric Nurse Associates & Practitioners, 23(2), 117–125. https://doi.org/10.1016/j.pedhc.2008.03.001.
Maltais, C., Cyr, C., Parent, G., & Pascuzzo, K. (2019). Identifying effective interventions for promoting parent engagement and family reunification for children in out-of-home care: A series of meta-analyses. Child Abuse & Neglect, 88, 362–375.
McCart, M. R., & Sheidow, A. J. (2016). Evidence-based psychosocial treatments for adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division, 45(5), 529–563. https://doi.org/10.1080/15374416.2016.1146990.
Mendez, J. L., Carpenter, J. L., LaForett, D. R., & Cohen, J. S. (2009). Parental engagement and barriers to participation in a community-based preventive intervention. American Journal of Community Psychology, 44(1–2), 1–14. https://doi.org/10.1007/s10464-009-9252-x.
Morse, J. M. (2015). Data Were Saturated. …. Qualitative Health Research, 25(5), 587–588. https://doi.org/10.1177/1049732315576699.
Nankervis, K., Rosewarne, A., & Vassos, M. (2011). Respite and parental relinquishment of care: A comprehensive review of the available literature. Journal of Policy and Practice in Intellectual Disabilities, 8(3), 150–162.
Newacheck, P. W., & Kim, S. E. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics & Adolescent Medicine, 159(1), 10–17. https://doi.org/10.1001/archpedi.159.1.10.
NVivo. (2018). NVivo qualitative data analysis software, Version 12. QSR International Pty Ltd.
Porterfield, S. L., & DeRigne, L. (2011). Medical home and out-of-pocket medical costs for children with special health care needs. Pediatrics, 128(5), 892–900. https://doi.org/10.1542/peds.2010-1307.
Reardon, T., Harvey, K., Baranowska, M., O’Brien, D., Smith, L., & Creswell, C. (2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child & Adolescent Psychiatry, 26(6), 623–647. https://doi.org/10.1007/s00787-016-0930-6.
Saechao, F., Sharrock, S., Reicherter, D., Livingston, J. D., Aylward, A., & Whisnant, J., et al. (2012). Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States. Community Mental Health Journal, 48(1), 98–106. https://doi.org/10.1007/s10597-011-9419-4.
Schwartz, R. H., O’Laughlen, M. C., & Kim, J. (2017). Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric-mental health training to nurse practitioners. Journal of the American Association of Nurse Practitioners, 29(6), 348–355. https://doi.org/10.1002/2327-6924.12450.
Seliner, B., Latal, B., & Spirig, R. (2016). When children with profound multiple disabilities are hospitalized: A cross-sectional survey of parental burden of care, quality of life of parents and their hospitalized children, and satisfaction with family-centered care. Journal for Specialists in Pediatric Nursing, 21(3), 147–157. https://doi.org/10.1111/jspn.12150.
Shabat, J. C., Lyons, J. S., & Martinovich, Z. (2008). Exploring the relationship between conduct disorder and residential treatment outcomes. Journal of Child and Family Studies, 17(3), 353–371. https://doi.org/10.1007/s10826-007-9146-1.
Soeken, K. L., McFarlane, J., Parker, B., & Lominack, M. C. (1998). The Abuse Assessment Screen: A clinical instrument to measure frequency, severity, and perpetrator of abuse against women. In Empowering survivors of abuse: Health care for battered women and their children (pp. 195–203). Sage Publications, Inc.
Stroul, B. A., & Manley, E. (2018). Custody relinquishment to obtain children’s behavioral health services: Current findings and strategies to address the practice. In 31st Annual Research and Policy Conference on Child, Adolescent, and Young Adult Behavioral Health, Tampa, FL.
U.S. Department of Health and Human Services. (2015). A national look at the use of congregate care in child welfare. https://www.acf.hhs.gov/sites/default/files/cb/cbcongregatecare_brief.pdf
von Sydow, K., Retzlaff, R., Beher, S., Haun, M. W., & Schweitzer, J. (2013). The efficacy of systemic therapy for childhood and adolescent externalizing disorders: A systematic review of 47 RCT. Family Process, 52(4), 576–618. https://doi.org/10.1111/famp.12047.
Williams, M. E., Latta, J., & Conversano, P. (2008). Eliminating the wait for mental health services. The Journal of Behavioral Health Services & Research, 35(1), 107–114. https://doi.org/10.1007/s11414-007-9091-1.
Wilmshurst, L. A. (2002). Treatment programs for youth with emotional and behavioral disorders: An outcome study of two alternate approaches. Mental Health Services Research, 4(2), 85–96. https://doi.org/10.1023/A:1015200200316.
Yampolskaya, S., Mowery, D., & Dollard, N. (2014). Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care. American Journal of Orthopsychiatry, 84(3), 234–243. https://doi.org/10.1037/h0099808.
Zinn, A., & Havlicek, J. (2014). Pathways to residential care: Latent class and confirmatory analyses of adolescents’ adverse placement event histories. Social Service Review, 88(3), 367–406. https://doi.org/10.1086/677569.
Acknowledgements
The authors would like to offer their special thanks to all of the women who participated in the study.
Funding
This study was supported by the University of Missouri Sinclair School of Nursing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix: Semi Structure Interview Guide
Appendix: Semi Structure Interview Guide
-
1.
First question—ask about child, RTC admission history, what brought them there. (Brief history)?
-
How has having your child in the RTC affected you? What are the good and bad things about this?
-
In what ways are parents involved in the RTC treatment plan?
-
What services, support, or help have the RTC staff or providers offered you as a parent?
-
-
2.
Ask about the child’s behaviors, including specific emphasis on externalizing behaviors—maybe define, or give examples. How has this impacted the family?
Probes, if needed:
-
How has it impacted her?
-
Her relationship w/child?
-
Her relationship w/partner?
-
-
3.
We know that violence against women is really common, and can be a health issue for both moms and kids. Because of that, I’d like to ask you about your recent (like past-year) experience or experiences with your partner/ex-partner who did things to hurt you physically, sexually, or emotionally. Please remember everything you tell me is confidential, and we can take a break anytime. Can you tell me more about what that has been like for you?
Probes, if needed:
-
How do you think these things have impacted you?
-
How do you think these recent experiences impacted your child who is in RTC?
-
How have these experiences influenced your child’s behavior, or treatment?
-
How did the RTC staff or programs address this issue in your child’s care? (If they didn’t, would you have wanted them to?)
-
How did the RTC staff or programs support you to stay safe? (If they didn’t, would you have wanted them to?)
-
-
4.
Have you experienced partner violence or other kinds of violence before this past year – during your child’s lifetime or when you were pregnant with them? If so, can you tell me more about what that has been like for you?
Probes, if needed:
-
How do you think these things have impacted you?
-
How do you think these recent experiences impacted your child who is in RTC?
-
How have these experiences influenced your child’s behavior, or treatment?
-
How did the RTC staff or programs address this issue in your child’s care?
-
How did the RTC staff or programs support you to stay safe?
-
-
5.
(If child still in RTC) What are your concerns about what will happen when your child is released from the RTC?
-
Where do you expect they will go? (home?)
-
What do you think will happen when they come home?
-
How do you think having this child come home will impact your family? Your relationship with your partner? The likelihood of violence occurring in the family?
-
What kind of support, help, services do you hope the RTC will offer?
-
-
6.
(If child no longer in RTC) What happened when your child was released?
-
Where did they go? (home?)
-
How did this impact your family? Your relationship with your partner?
-
Did your partners’ abusive behavior change? How did it change?
-
What kind of support, help, services were you offered? How did you feel about these? What else did you need?
-
-
7.
What could have been helpful to you and your child before the RTC experience? Probe: any supportive services? Education?
-
8.
What could have been/could be helpful to you and your child after your child gets out of the RTC?
-
9.
If you had a magic wand and could do anything you want to help women like yourself and their children, what would you do?
-
10.
What’s the most important thing you want me to remember from this conversation?
Is there anything I didn’t ask you about that I should have?
Rights and permissions
About this article
Cite this article
Herbell, K., Banks, A.J. “Fighting Tooth and Nail”: Barriers to Accessing Adolescent Mental Health Treatment from Mothers Perspectives. Adm Policy Ment Health 47, 935–945 (2020). https://doi.org/10.1007/s10488-020-01026-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-020-01026-1