Abstract
Background
Child and family mental health services remain largely underutilized despite the relatively high rate of youth suffering from mental, emotional, and behavioral disorders. As such, it is important to address challenges and examine factors related to child mental health service use and engagement, especially when it comes to children in need of services for anxiety.
Objective
Informed by the behavioral model of health services use, the present study sought to examine predictors of service use and engagement for families seeking assistance for their anxious children. Initial levels of engagement in culturally tailored services were predicted from predisposing characteristics (e.g., child age, ethnicity), enabling resources (e.g., Spanish services, transportation), and need characteristics (e.g., child clinical severity).
Methods
Participants included Latino (n = 126) and Caucasian (n = 116) families who presented to a specialty clinic due to child emotional and behavior problems related to anxiety. Initial service utilization and engagement was assessed along the following levels toward services care: (1) initiated contact and completed a clinical intake, (2) completed a home screen, and (3) completed an on-site diagnostic assessment. All procedures were culturally tailored to the presenting needs of families.
Results
Predisposing characteristics, enabling resources and need characteristics emerged as significant predictors of child mental health service use, with some variations. Child age, ethnicity, referral source, and enabling resources predicted completion of a home screen. Proximity to services predicted completion of the on-site diagnostic assessment.
Conclusion
Knowledge of factors that predict engagement in child mental health services can help identify avenues to promote service utilization, especially among ethnic minority children and families. Our culturally tailored approach to serving families appears to be promising in bridging the cross-ethnic services gap and therefore has implications for practice.
Similar content being viewed by others
References
Achenbach, T. M. (1991). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.
Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328–340. doi:10.1207/S15374424JCCP3203_02.
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA: Sage Publications.
Aiken, L. S., West, S. G., Woodward, C. K., Reno, R. R., & Reynolds, K. D. (1994). Increasing screening mammography in asymptomatic women: Evaluation of a second-generation, theory-based program. Health Psychology, 13, 526–538. doi:10.1037/0278-6133.13.6.526.
Alegría, M., Canino, G., Ríos, R., Vera, M., Calderón, J., Rusch, D., et al. (2002). Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatric Services, 53, 1547–1555. doi:10.1176/appi.ps.53.12.1547.
Alegría, M., Lin, J. Y., Green, J. G., Sampson, N. A., Gruber, M. J., & Kessler, R. C. (2012). Role of referrals in mental health service disparities for racial and ethnic minority youth. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 703–711. doi:10.1016/j.jaac.2012.05.005.
Alfano, C. A., Pina, A. A., Zerr, A. A., & Villalta, I. K. (2010). Pre-sleep arousal and sleep problems of anxiety-disordered youth. Child Psychiatry and Human Development, 41, 156–167. doi:10.1007/s10578-009-0158-5.
Alvidrez, J. (1999). Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women. Community Mental Health Journal, 35, 515–530. doi:10.1023/A:1018759201290.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10. doi:10.2307/2137284.
Andersen, R. M. (2008). National health surveys and the behavioral model of health services use. Medical Care, 46, 647–653. doi:10.1097/MLR.0b013e31817a835d.
Andersen, R. M., Hongjian Yu, R., Wyn, P. L., Brown, E. R., & Teleki, S. (2002). Access to medical care for low-income persons: How do communities make a difference? Medical Care Research and Review, 59, 384–411. doi:10.1177/107755802237808.
Barrett, P. M., & Turner, C. M. (2004). Prevention strategies. In T. L. Morris & J. S. March (Eds.), Anxiety disorders in children and adolescents (2nd ed., pp. 371–386). New York, NY: Guilford Press.
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, 14, 147–159. doi:10.1377/hlthaff.14.3.147.
Cabassa, L. J. (2007). Latino immigrant men’s perceptions of depression and attitudes toward help seeking. Hispanic Journal of Behavioral Sciences, 29, 492–509. doi:10.1177/0739986307307157.
Cardemil, E. V., Adams, S. T., Calista, J. L., Connell, J., Encarnación, J., Esparza, N. K., et al. (2007). The Latino mental health project: A local mental health needs assessment. Administration and Policy in Mental Health and Mental Health Services Research, 34, 331–341. doi:10.1007/s10488-007-0113-3.
Chavira, D. A., Garland, A., Yeh, M., McCabe, K., & Hough, R. L. (2009). Child anxiety disorders in public systems of care: Comorbidity and service utilization. The Journal of Behavioral Health Services & Research, 36, 492–504. doi:10.1007/s11414-008-9139-x.
Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20, 155–164. doi:10.1002/da.20039.
Conger, R. D., & Rueter, M. A. (1996). Siblings, parents, and peers: A longitudinal study of social influences in adolescent risk for alcohol use and abuse. In G. H. Brody (Ed.), Sibling relationships: Their causes and consequences (pp. 1–30). Westport, CT: Ablex Publishing.
Deacon, B., Lickel, J., & Abramowitz, J. S. (2008). Medical utilization across the anxiety disorders. Journal of Anxiety Disorders, 22, 344–350. doi:10.1016/j.janxdis.2007.03.004.
Diefenbach, G. J., Robison, J. T., Tolin, D. F., & Blank, K. (2004). Late-life anxiety disorders among Puerto Rican primary care patients: Impact on well-being, functioning, and service utilization. Journal of Anxiety Disorders, 18, 841–858. doi:10.1016/j.janxdis.2003.10.005.
Dillman Carpentier, F. R., Mauricio, A. M., Gonzales, N. A., Millsap, R. E., Meza, C. M., Dumka, L. E., et al. (2007). Engaging Mexican origin families in a school-based preventive intervention. The Journal of Primary Prevention, 28, 521–546. doi:10.1007/s10935-007-0110-z.
Dobalian, A., & Rivers, P. A. (2008). Racial and ethnic disparities in the use of mental health services. The Journal of Behavioral Health Services & Research, 35, 128–141. doi:10.1007/s11414-007-9097-8.
Documét, P. I., & Sharma, R. K. (2004). Latinos’ health care access: Financial and cultural barriers. Journal of Immigrant Health, 6, 5–13. doi:10.1023/B:JOIH.0000014638.87569.2e.
Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., Higa-McMillan, C. K., & Weisz, J. R. (2010). Concurrent validity of the child behavior checklist DSM-oriented scales: Correspondence with DSM diagnoses and comparison to syndrome scales. Journal of Psychopathology and Behavioral Assessment, 32, 373–384. doi:10.1007/s10862-009-9174-9.
Farmer, E. M., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54, 60–66. doi:10.1176/appi.ps.54.1.60.
Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Medical Care, 40, 52–59. doi:10.1097/00005650-200201000-00007.
Flores, G., Abreu, M., Olivar, M. A., & Kastner, B. (1998). Access barriers to health care for Latino children. Archives of Pediatrics and Adolescent Medicine, 152, 1119–1125.
Flores, G., & Vega, L. R. (1998). Barriers to health care access for Latino children: A review. Family Medicine, 30, 196–205.
Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70, 439–443. doi:10.1037/0022-006X.70.2.439.
Ginsburg, G. S., & Silverman, W. K. (1996). Phobic and anxiety disorders in Hispanic and Caucasian youth. Journal of Anxiety Disorders, 10, 517–528. doi:10.1016/S0887-6185(96)00027-8.
Halfon, N., Wood, D. L., Valdez, R. B., Pereyra, M., & Duan, N. (1997). Medicaid enrollment and health services access by Latino children in inner-city Los Angeles. Journal of the American Medical Association, 277, 636–641. doi:10.1001/jama.1997.03540320038032.
Horwitz, S. M., Gary, L. C., Briggs-Gowan, M. J., & Carter, A. S. (2003). Do needs drive services use in young children? Pediatrics, 112, 1373–1378. doi:10.1542/peds.112.6.1373.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. The American Journal of Psychiatry, 159, 1548–1555. doi:10.1176/appi.ajp.159.9.1548.
Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65, 883–888. doi:10.1037/0022-006X.65.5.883.
Leaf, P. J., Bruce, M. L., Tischler, G. L., & Holzer, C. E. (1987). The relationship between demographic factors and attitudes toward mental health services. Journal of Community Psychology, 15, 275–284. doi:10.1002/1520-6629(198704)15:2<275:AID-JCOP2290150216>3.0.CO;2-J.
Lewis, M. J., West, B., Bautista, L., Greenberg, A. M., & Done-Perez, I. (2005). Perceptions of service providers and community members on intimate partner violence within a Latino community. Health Education & Behavior, 32, 69–83. doi:10.1177/1090198104269510.
Magaña, S. M., García, J. I. R., Hernández, M. G., & Cortez, R. (2007). Psychological distress among Latino family caregivers of adults with schizophrenia: The roles of burden and stigma. Psychiatric Services, 58, 378–384. doi:10.1176/appi.ps.58.3.378.
McLaughlin, K. A., Hilt, L. M., & Nolen-Hoeksema, S. (2007). Racial/ethnic differences in internalizing and externalizing symptoms in adolescents. Journal of Abnormal Child Psychology, 35, 801–806. doi:10.1007/s10802-007-9128-1.
Merikangas, K., He, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the national comorbidity study-adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989. doi:10.1016/j.jaac.2010.05.017.
Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the child behavior checklist DSM-oriented scales. Journal of Psychopathology and Behavioral Assessment, 31, 178–189. doi:10.1007/s10862-008-9119-8.
National Research Council and Institute of Medicine (NCR/IOM). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.
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, 731–738. doi:10.1097/00004583-200206000-00013.
Pew Hispanic Center. (2007). Indicators of recent migration flows from Mexico. Retrieved June 14, 2011 from http://pewhispanic.org/files/factsheets/33.pdf.
Pina, A. A., & Silverman, W. K. (2004). Clinical phenomenology, somatic symptoms, and distress in Hispanic/Latino and European American youths with anxiety disorders. Journal of Clinical Child and Adolescent Psychology, 33, 227–236. doi:10.1207/s15374424jccp3302_3.
Pina, A. A., Silverman, W. K., Weems, C. F., Kurtines, W. M., & Goldman, M. L. (2003). A comparison of completers and noncompleters of exposure-based cognitive and behavioral treatment for phobic and anxiety disorders in youth. Journal of Consulting and Clinical Psychology, 71, 701–705. doi:10.1037/0022-006X.71.4.701.
Pina, A. A., Villalta, I. K., & Zerr, A. A. (2009). Psychosocial treatment of anxiety in Latino youth: An emerging culturally-prescriptive framework. Behavioral Psychology/Psicología Conductual, 17, 111–135.
Pina, A. A., Zerr, A. A., Villalta, I. K., & Gonzales, N. A. (2012). Indicated prevention and early intervention for childhood anxiety: A randomized trial with Caucasian and Hispanic/Latino youth. Journal of Consulting and Clinical Psychology, 80, 940–946. doi:10.1037/a0029460.
Portes, A., Kyle, D., & Eaton, W. W. (1992). Mental illness and help-seeking behavior among Mariel Cuban and Haitian refugees in south Florida. Journal of Health and Social Behavior, 33, 283–298. doi:10.2307/2137309.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395. doi:10.1037/0022-006X.51.3.390.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behavior. American Psychologist, 47, 1102–1114. doi:10.1037/0003-066X.47.9.1102.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38–48. doi:10.4278/0890-1171-12.1.38.
Roosa, M. W., Liu, F. F., Torres, M., Gonzales, N. A., Knight, G. P., & Saenz, D. (2008). Sampling and recruitment in studies of cultural influences on adjustment: A case study with Mexican Americans. Journal of Family Psychology, 22, 293–302. doi:10.1037/0893-3200.22.2.293.
Scheppers, E., van Dongen, E., Dekker, J., Geertzen, J., & Dekker, J. (2006). Potential barriers to the use of health services among ethnic minorities: A review. Family Practice, 23, 325–348. doi:10.1093/fampra/cmi113.
Shi, L., & Stevens, G. D. (2005). Disparities in access to care and satisfaction among US children: The roles of race/ethnicity and poverty status. Public Health Reports, 120, 431–441.
Tanner, J. L., Cockerham, W. C., & Spaeth, J. L. (1983). Predicting physician utilization. Medical Care, 21, 360–369. doi:10.1097/00005650-198303000-00008.
United States Census Bureau. (2010). Profile of general population and housing characteristics: 2010. Retrieved March 31, 2012, from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF2_SF2DP1&prodType=table.
Varela, R. E., Sanchez-Sosa, J. J., Biggs, B. K., & Luis, T. M. (2008). Anxiety symptoms and fears in Latin American and European American children: Cross-cultural measurement equivalence. Journal of Psychopathology and Behavioral Assessment, 30, 132–145. doi:10.1007/s10862-007-9056-y.
Vega, W. A., Kolody, B., & Aguilar-Gaxiola, S. (2001). Help seeking for mental health problems among Mexican Americans. Journal of Immigrant Health, 3, 133–140. doi:10.1023/A:1011385004913.
Weathers, A., Minkovitz, C., O’Campo, P., & Dierner-West, M. (2003). Health services use by children of migratory agricultural workers: Exploring the role of need for care. Pediatrics, 111, 956–963. doi:10.1542/peds.111.5.956.
Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research, 5, 65–77. doi:10.1023/A:1023286210205.
Acknowledgments
This study was supported in part by award numbers K01MH086687 and L60MD001839 from the National Institute of Mental Health and the National Center on Minority Health and Health Disparities, as well as funding from the Institute for Mental Health Research awarded to A. Pina.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zerr, A.A., Pina, A.A. Predictors of Initial Engagement in Child Anxiety Mental Health Specialty Services. Child Youth Care Forum 43, 151–164 (2014). https://doi.org/10.1007/s10566-013-9230-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-013-9230-1