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

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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.

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REFERENCES

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Hoberman, H. M. (1992). Ethnic minority status and adolescent mental health services utilization. The Journal of Mental Health Administration, 19, 246-267.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Ramsey, E. & Walker, H. (1988). Family management connection with antisocial behavior among middle school boys. Behavioral Disorders pp. 187-201.

  • 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 

  • 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 

  • 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 

  • Snowden, L. R. (1998). Racial differences in informal help seeking for mental health problems. Journal of Community Psychology, 26, 429-438.

    Google Scholar 

  • Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3, 181-187.

    Google Scholar 

  • 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 

  • Staudt, M. M. (2003). Helping Children Access and Use Services: A Review. Journal of Child and Family Studies, 12, 49-60.

    Google Scholar 

  • Tharp, R. G. (1991). Cultural diversity and the treatment of children. Journal of Consulting and Clinical Psychology, 59, 799-812.

    Google Scholar 

  • Tolan, P. H. & Gorman-Smith, D. (1991). Metropolitan Area Child Study Parent Questionnaire. University of Illinois at Chicago.

  • 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.

  • Wahler, R. & Dumas, J. (1989). Attentional problems in dysfunctional mother-child interactions: An interbehavior model. Psychological Bulletin 105, 116-130.

    Google Scholar 

  • 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 

  • 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 

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Harrison, M.E., McKay, M.M. & Bannon, W.M. Inner-City Child Mental Health Service Use: The Real Question Is Why Youth and Families Do Not Use Services. Community Ment Health J 40, 119–131 (2004). https://doi.org/10.1023/B:COMH.0000022732.80714.8b

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