Barriers to Mental Health Care for Urban, Lower Income Families Referred from Pediatric Primary Care

Abstract

The aim of this study was to evaluate the association of parent-reported barriers on the likelihood of attending a mental health evaluation after referral from pediatric primary care. As the part of procedure, parents of children (N = 55) referred for mental health from primary care completed a 23-item questionnaire (three subscales; Cronbach alpha > 0.7): intangible barriers, tangible barriers, and child functioning. Logistic regression examined associations between responses and referral follow-through. The results showed that the high levels of intangible barriers were associated with decreased odds of attending the mental health evaluation (OR = 0.20, 0.06-0.83; P = 0.03). Therefore, we conclude that parental concerns about mental health care may be important for engagement in treatment.

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

“…Some quantitative studies, however, asked more open questions about the reasons for not seeking help or difficulties associated with seeking help/attending services/accessing services. Only two quantitative studies provided data relating to perceived facilitators of accessing mental health services [37, 38]. The amount of relevant quantitative data reported across studies ranged from data relating to responses to a single question [39, 40] or particular questionnaire subscales [23], through studies reporting a breakdown of responses to a large number of questionnaire items [26, 38, 41].…”

“…Quantitative studies often asked participants to rate ‘inconvenient (appointment) times’ as a possible barrier, although typically, only a small minority of participants rated this as a barrier [38, 41, 53, 59]. Qualitative studies also identified the cumbersome administrative system [56] and various aspects of the appointment system [44, 45, 57, 61] as perceived barriers/facilitators.…”

“…Trust and confidence in professionals and the existence/absence of a trusting relationship with professionals were reported as a barrier/facilitator in both quantitative [26, 38, 46, 70] and qualitative studies [45, 55, 60, 63, 66, 71]. Concerns surrounding confidentiality of discussions with professionals, broader perceptions of the nature, and quality of services, and the previous experience with services were also identified as perceived barriers/facilitators among quantitative and qualitative studies.…”

“…Similarly, between 12 and 26% of parents reported not wanting/not needing help across a quarter of quantitative samples [38, 49, 50, 70, 76], and recognition of the need for help or parental willingness to seek help was similarly cited as barriers/facilitators to help seeking in a number of qualitative studies [44, 58, 74, 75, 78]. A lack of family recognition, the presence/absence of recognition by the child themselves, and a child’s own reluctance to seek help were also reported as helping/hindering help seeking in some studies.…”

Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting

“…As a core concept, a PCP's awareness of the barriers to care, and ability to discuss them with families in a sensitive and culturally competent way, increases access by empowering families to engage in their child's mental health care. 63 Yet given limitations on providers' time, the complexity of most local mental health care delivery systems, and the needs of families living in poverty, targeted care coordination may increase successful linkages from primary care to the community. Care coordination, a collaborative and family-centered approach to organizing health care delivery, is considered to be an essential component of the medical home 64,65 that has been effective for children in low-income households.…”