Organizational context and provider perception as determinants of mental health service use

Abstract

This study refines and tests an individual client model of service use and contrasts it with a model of service provision based on gateway provider perspectives. Structural equation models demonstrate that provider variables account for more service use variation than client variables. The client model accounts for 24% of the variance in service use, while the provider model accounts for 55% of the variance. Youth self-reported mental health was not positively associated with increased services or with provider perception of youth mental health. The provider model demonstrates the critical role played by provider perceptions, which are influenced more by work environment than by client problems.

Identification of Youth Psychosocial Problems During Pediatric Primary Care Visits

“…Our sample size of youth and PCPs was similar to previous investigations of identification (Costello et al, 1988;Chang et al, 1990;Stiffman, 2001). However, we should note that the clustered design of our data and the application of the random effects model limit the power to detect significant differences in proportions.…”

Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

“…In this retrospective study of youth suicide deaths, well-established risk factors including the expression of suicidal thoughts were identifiable in most cases as warning signs of impending self-injurious behavior (CDC-MMWR, 2004). The rationale for teaching staff about mental health services also is supported by evidence that adults with knowledge of services more frequently direct youths to treatment (Stiffman et al, 2001). According to the surveillance model, gatekeeper training should have a relatively comparable impact across trained staff, in which case modest increases in knowledge and attitudes could raise exponentially the overall rate of referrals of suicidal youths in a school (Brown et al, 2006).…”

Correlates of voluntary HIV testing and counseling among middle aged and older Latinas :

“…They also found that predisposing and enabling categories generally had low relative importance in the utilization of these services. Although the health care landscape has changed during the past thirty three years many studies still find that need mediates the influence of predisposing and enabling factors on service use (Stiffman et al, 2001). …”

“…Despite their role as the first and often only interaction for a vulnerable patient within a health care system, primary care providers often do not accurately perceive patient needs (Stiffman et al, 2001;Taira et al, 1997) which can be a determinant of service access (Stiffman et al, 2000). Although such measures can be difficult to conceptualize during research design, the reduction of health disparities requires that we understand both the influences on service use and the gap between need and access (Stiffman et al, 2001).…”

“…Although such measures can be difficult to conceptualize during research design, the reduction of health disparities requires that we understand both the influences on service use and the gap between need and access (Stiffman et al, 2001). Although many studies of service use typically use only individual level variables, the ABM could be strengthened when provider data is included.…”