Behavioral Health Needs, Barriers, and Parent Preferences in Rural Pediatric Primary Care

Abstract

Objective The goal of this study was to examine modifiable factors related to health disparities by exploring the role of predisposing, need, and enabling characteristics on mental/behavioral health treatment-seeking behaviors in a rural sample. Parental treatment preferences and knowledge about treatment options were also examined. Methods One hundred eighteen parents completed questionnaires assessing demographics, child prior psychological treatment, child psychological symptoms, barriers to care, mental health stigma, and willingness to seek services across settings. Questions also assessed preferences for treatment, awareness of behavioral/mental health services, and knowledge of community treatment options. Results Prior treatment use and stigma significantly predicted willingness to seek services in a doctor’s office after controlling for predisposing (demographic) and need characteristics (psychological symptoms). Symptom severity and barriers significantly differentiated between parents who previously sought treatment or reported an unmet treatment need from those who reported no prior treatment and no treatment need. Families overwhelmingly (94%) reported a preference for individual versus group treatment, and up to 10 sessions were most commonly reported (38%) as the ideal number of sessions. Forty percent of respondents reported no knowledge of treatment options in their community. Conclusions These results highlight the role of enabling characteristics (i.e., stigma, barriers to care, psychological symptoms) and prior service use in understanding parental treatment seeking in a rural sample. Overall, these results support integrated behavioral health in rural settings. Understanding modifiable factors and parent treatment preferences and knowledge may be important to increase access to services and reduce health disparities in rural areas. Future research directions are discussed.

The efficacy of child–teacher relationship training as an early childhood mental health intervention in Head Start programs.

“…Children exhibiting social and emotional struggles in rural communities are often unable to receive necessary mental health services due to inadequate or inaccessible resources (Fehr et al, 2020; Pullmann et al, 2010). School-based interventions—and other nontraditional strategies for fostering healthy socialemotional development—are vital for supporting children in rural communities (Eckert et al, 2017; Smalley et al, 2010).…”

“…Mental health services in rural communities are frequently underfunded, unavailable, unaffordable, or inadequate (Pullmann et al, 2010; Smalley et al, 2010). Additionally, families in rural areas are less likely to access needed care, a decision that may be influenced by social norms, attitudes, and lack of awareness surrounding mental health services (Fehr et al, 2020; Pullmann et al, 2010; Smalley et al, 2010). In rural communities, less than 50% of the children exhibiting mental health concerns receive treatment for those concerns, leaving these children at-risk for experiencing numerous short- and long-term negative outcomes (Anderson et al, 2013; Fischer et al, 2014).…”

COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions

“…The increasing concentration of mental health providers in metropolitan regions and academic hubs further compounds these problems, resulting in widening geographic disparities in care ( American Psychological Association, 2018 ). As a result, children in remote geographic regions and rural areas are more than 20% less likely to receive mental health care, despite comparable rates of mental health problems ( Fehr et al, 2020 ). Children with moderate levels of impairment are particularly underserved, as they are 50% less likely to receive mental health services than children in urban and suburban regions ( Fehr et al, 2020 ).…”

“…As a result, children in remote geographic regions and rural areas are more than 20% less likely to receive mental health care, despite comparable rates of mental health problems ( Fehr et al, 2020 ). Children with moderate levels of impairment are particularly underserved, as they are 50% less likely to receive mental health services than children in urban and suburban regions ( Fehr et al, 2020 ).…”

“…Even if families do enroll in BPT, perceptions of stigma and concerns about confidentiality are also barriers to seeking and engaging in clinic-based BPT services ( Love et al, 2016 , Tarver et al, 2014 , Weisenmuller and Hilton, 2021 ). Moreover, these challenges each disproportionately impact communities of color and those living in rural regions ( Dixon De Silva et al, 2020 , Fehr et al, 2020 , Planey et al, 2019 ), further widening disparities in care.…”