Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Inmate Perceptions of Mental Health Services.

With the increasing rise in the U.S. prison population, meeting the mental health needs of inmates before, during, and after incarceration remains an obstacle. What are the mental health experiences of inmates? For what types of problems are inmates willing to seek help, and what are the barriers to their service utilization? This study investigated inmates' attitudes and perceptions toward mental health services and examined whether these attitudes and perceptions vary with respect to ethnic group membership or among inmates of differing security levels. Implications of these findings for psychologists, including psychologists not employed in correctional settings, are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supporting children's mental health in schools: Teacher perceptions of needs, roles, and barriers.

There is a significant research to practice gap in the area of mental health practices and interventions in schools. Understanding the teacher perspective can provide important information about contextual influences that can be used to bridge the research to practice gap in school-based mental health practices. The purpose of this study was to examine teachers' perceptions of current mental health needs in their schools; their knowledge, skills, training experiences and training needs; their roles for supporting children's mental health; and barriers to supporting mental health needs in their school settings. Participants included 292 teachers from 5 school districts. Teachers reported viewing school psychologists as having a primary role in most aspects of mental health service delivery in the school including conducting screening and behavioral assessments, monitoring student progress, and referring children to school-based or community services. Teachers perceived themselves as having primary responsibility for implementing classroom-based behavioral interventions but believed school psychologists had a greater role in teaching social emotional lessons. Teachers also reported a global lack of experience and training for supporting children's mental health needs. Implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Representativeness of clinical samples of youths with mental disorders: A preliminary population-based study.

In a household community sample of 1,285, 9–17 year-olds with mental disorders who had received outpatient specialty mental health services in the past year were compared with youths with mental disorders who had not received those services to determine if samples drawn from clinical settings are representative of youths with mental disorders in the general population. Those who had used services were more impaired, less competent, more likely to have comorbid disorders, more likely to belong to non-Hispanic White relative to other ethnic groups, and less likely to be prepubertal girls. Their parents were more educated, but less satisfied with family life, engaged in less monitoring of their children, and more likely to have used mental health services themselves. These findings suggest the hypothesis that samples of youths with mental disorders drawn from outpatient clinical settings are not representative of all youths with mental disorders. If confirmed, this would indicate the importance of population-based samples for the study of psychopathology in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward adoption of evidence-based practices: A comparison of autism early intervention providers and children’s mental health providers.

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASDs) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practices (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organizational culture and climate and mental health provider attitudes toward evidence-based practice.

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Availability of school health services for young children

A survey to assess availability of school health services was distributed to 221 directors of Schools of the 21st Century, an educational model that provides integrated services to children and families. Of this distribution, 126 (57%) surveys were returned; 88% of respondents reported they provided some type of school health services for their students; 75% of schools had access to school nursing services, yet only 33% had a school nurse on-site; 50% had less than daily access to a school nurse. Despite a high reported prevalence of physical and mental health problems, other services such as acute care, nutrition counseling, dental screenings, or mental health services were provided less frequently. Barriers perceived as problematic for schools providing health services included inadequate funding, limited parental awareness, and opposition by school or community members. Respondents believed transportation, limited financial resources, and inadequate health insurance were barriers to care for children and families. Among this sample of schools, school health services varied in availability and comprehensiveness. Educators, health providers, and parents must work together to provide improved school health services for children.     

African Americans' Perceptions of Psychotherapy and Psychotherapists.

Do you have a multicultural practice? Do you understand the attitudes and expectations African Americans hold about mental health services? The attitudes and beliefs of 201 African Americans regarding psychotherapists, psychotherapy, and barriers to treatment were explored by means of focus groups. Key banners to service utilization included stigma, lack of knowledge, lack of affordability, lack of trust, impersonal service, and lack of cultural understanding. Participants reported that race should not matter in therapy, but they often believed that psychologists were insensitive to the African American experience. The implications of participants' reports for meeting African American mental health and therapy needs are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brain metastasis model in athymic nude mice using a novel MUC1-secreting human breast-cancer cell line, MA11

OBJECTIVES: This study explored parental attitudes about their interactions with their children's providers when decision making involved critical life situations. We evaluated parents' attitudes regarding the following questions: What was the parents' understanding of their children's health care issues, and what was the parental perception of the professionals' understanding of their children and of themselves? Who should be the principal decision makers for the children? What was the parents' knowledge about advance directives? Did parents want to participate in a process of advance planning to assist with critical life decision making for their children? METHODS: We surveyed all parents attending a conference sponsored by the Massachusetts Department of Public Health for parents of children with special needs. The questionnaire was provided to all parents attending the conference. An announcement was made at the conference requesting parental participation. The 76 respondents constitute a convenience sample of parents of children with special needs sufficient for this preliminary stage of investigation. RESULTS: Of 177 parents attending the conference, 76 (43%) completed the questionnaire. Eighty-eight percent of the participants strongly agreed that they understood their children's conditions. Twenty-one percent stated that they had sufficient understanding of their children's future medical needs, and 21% thought that they had a sufficient understanding of their children's developmental potential. Ninety-nine percent of parents strongly agreed that physicians should share information with parents no matter how serious or potentially upsetting. Ninety-four percent of those parents who thought that their children's physicians understood their own needs also thought that the physicians understood their children's needs. In contrast, only half (55%) of those parents who thought the physicians did not understand their needs thought the physicians understood their children's needs. Ninety-two percent of parents who thought that the physicians understood their needs agreed that the physicians would make the best decisions in crises versus 60% of those who did not think the physicians understood their needs. Seventy-four percent stated that they would consider written guidelines for their children that dealt with critical life situations. All parents who thought their children's conditions were not understood wanted written guidelines. Of those parents who had thought their children would not survive (15 parents), 94% wanted written guidelines. All seven parents who had been told their children would not survive wanted written guidelines. CONCLUSIONS: Parents in this study were generally satisfied with care being provided to their children. Nevertheless, the results clearly suggest goals that could lead to improved capacity for parents and providers to make critical life decisions for and with children. First, physicians must understand the needs of parents to be able to make decisions that would be in the children's best interests. Second, parents should participate fully in critical life decisions for their children and should use written guidelines to assist with the process of these critical life decisions. Our findings strongly support the development of a longitudinal process, initiated early after the onset or discovery of illness and maintained longitudinally throughout the course of a child's illness, to help parents and providers work together in this vital area of health care to children.     

Children's perceptions of parental work.

249 3rd and 4th graders and both of their parents were asked about the nature of the parents' work, their attitudes toward it, and a variety of other work-related questions. The children knew in general what their parents did, where, and when. They were also somewhat aware of their parents' satisfaction with their work. Mothers who were homemakers were perceived by their children to be less satisfied with their work than were mothers in the paid labor force. However, the children were equally satisfied with the work of both groups. Children were dissatisfied with their parents' work only when their mothers worked evening or night shifts. Results are discussed in terms of the role played by parental work in the process of socialization of children regarding work. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships of parents' perceived actions toward their children

Research has generally supported the view that parents' attitudes and practices predispose children to act in certain ways. Bell (1968), however, proposed an alternate theory which suggested that children and adolescents often mold the way their parents act. Parish (1980) subsequently reported support for Bell's position in that parents were, indeed, found to parent like one another, possibly in response to their children's actions. The present study sought to further examine the Bell (1968) theory by seeking to determine if parents are consistent with each other or with themselves in their parenting attitudes and practices. Parents were perceived to act like one another (at least to a moderately significant degree), but fathers were much more likely to parent in particular ways (i.e., if they were restrictive they were also more likely to be warm, or if they were permissive they were also more likely to be hostile), independent of how their wives were perceived to act. The implications of these findings are discussed.     

My children and me: Midlife evaluations of grown children and of self.

215 midlife parents (mean age 53.7 yrs) were interviewed about how their adult children (mean age 27.6 yrs) had "turned out." These assessments were then related to parents' views of themselves. Perceived accomplishments and adjustment of children were expected to be positively linked with parents' well-being (e.g., self-acceptance, environmental mastery, purpose in life), and social comparisons were hypothesized to contribute to the link between parents' assessments of children and their own well-being. Multiple regression analyses revealed that children's perceived adjustment significantly predicted 6 of 7 well-being outcomes for mothers and fathers. Children's attainment was less strongly linked with parental outcomes. Personal comparisons were significant negative predictors: Parents who saw their children as better adjusted than themselves had lower well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude of clinicians toward use of computers in hospital settings.

Reports describing the application of computer technology suggest that mental health professionals have a predominantly hostile attitude toward computerized information systems. This study explored the attitudes of a group of psychologists and psychiatrists toward use of computers in hospital settings. Their perception of a computer-assisted interview procedure was compared with that of a routine manual system of collecting information on children and adolescents attending a mental health service. The study also investigated the impact of the computer-assisted interview procedure on clinicians' attitudes toward the general use of computers in hospital settings. The computer-assisted interview was generally perceived favorably by clinicians, whereas the problem of resistance toward computers by mental health professionals, frequently described in anecdotal reports, was not identified in this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohort differences in attitudes toward mental health services among older persons.

In order to investigate historical shifts in attitudes toward mental health and mental health services, two independent samples of older adults separated by a 14-year time interval were administered questionnaires. There were 91 in the 1977 sample (mean age 69.91 yrs) and 116 in the 1991 sample (mean age 71.94 yrs). Four newly created, internally consistent scales assessed multiple dimensions of their mental health attitudes (breadth of conceptions, bias, openness to help, range of problems). Analyses suggested that the younger cohorts of older adults held more positive attitudes toward mental health and mental health services than the older cohorts. These cohort differences remained when controlled for age, level of education, self-reported health, and income. These data indicate a positive cohort shift in attitudes toward mental health, a finding with numerous implications for the design and implementation of mental health services for future cohorts of older persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing service utilization and mood symptom severity in children with mood disorders: Effects of multifamily psychoeducation groups (MFPGs).

This study investigated the impact of psychoeducation on service utilization and mood symptom severity in children with mood disorders. Parents’ knowledge of mood disorders, beliefs about treatment, and perceptions of children’s need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and between psychoeducation and mood symptom severity. Linear mixed effects modeling and joint significance test for mediation were used in secondary data analyses of the multifamily psychoeducation group (MFPG) study, a randomized controlled trial of 165 children ages 8 to 12 years with mood disorders. A majority of those sampled were male (73%) and White, non-Hispanic (90%), and the median range of family income was $40,000–$59,000. Participation in MFPG significantly improved quality of services utilized, mediated by parents’ beliefs about treatment. Participation in MFPG also significantly improved severity of child’s mood symptoms, mediated by quality of services utilized. MFPG appears to be a psychoeducational intervention that helps parents to become better consumers of the mental health system who access higher quality services. Children’s symptom severity decreases as a result. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's mental health problems and services: Current federal efforts and policy implications.

This article discusses the current federal role in the collection of information about the mental health problems of children and the provision of mental health services to children. It also describes the federal programs that help finance mental health services, support their coordination, and provide funding for research and training of mental health researchers and clinicians. Recent changes in federal policy are also described. This article, and the Office of Technology Assessment report on which it is based, conclude that although it is in some ways considerable, the federal role in providing mental health services to children is fragmented. This lack of cohesive policies toward children and across service programs may create difficulties for those who would move public policy toward the continuum of care that many observers conclude is needed to address children's mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing

OBJECTIVE: To examine the feasibility of conducting a reverse record-check study to validate parent reporting on child mental health service use and to examine the accuracy of parent reports of child mental health services. METHOD: Information about child service use was abstracted from medical records and subsequently compared with reports provided by caregivers in telephone interviews. A sample of children using outpatient psychiatric services was compared with a sample of children using outpatient orthopaedic services. Rates and correlates of successful caregiver tracking and of service use reporting accuracy were explored. RESULTS: Caregivers of nearly 30% of all index children were contacted and interviewed. Parent reports of lifetime mental health service use were more accurate than reports of lifetime receipt of orthopaedic services. Elapsed time between survey interview and last treatment episode was negatively associated with reporting accuracy. Number of clinic visits was positively associated with reporting accuracy. Preliminary findings suggested that questions about mental health services may be considered sensitive by parents whose children use them. CONCLUSIONS: Reverse record-check studies based on telephone interviews are potentially problematic with a sample drawn from a large, inner-city medical center. Findings suggest that memory difficulties may be a more important correlate of reporting accuracy than response editing (social desirability). Potential discomfort with disclosure of mental health service use does not result in service use underreporting.     

Genetic heterogeneity in lamellar ichthyosis

One of the major challenges facing obstetrician-gynecologists, especially those serving populations that are diverse in culture and circumstances, is to identify and address the barriers that keep women from seeking timely preventive and prenatal health care. The Department of Obstetrics and Gynecology at Rochester General Hospital held a community focus groups to learn more about women's attitudes toward health care. In addition to economic issues, such as lack of insurance and an inability to pay, the organizers found that many of the factors that prevent or discourage women from seeking health care involve issues of communication and understanding. Many women wanted what they perceived to be additional services. In reality, many of the things desired involved changes in doctor-patient interactions rather than the addition of any new service, and could be addressed with relative ease and minimal cost. Providing staff members with training in cultural sensitivity and encouraging them to develop a real awareness of patient circumstances are first steps that can lead to better communication between provider and patient and to the development of mutual trust. Other factors, such as the fear of incarceration or of losing one's children if health care is sought, present more serious challenges. Providers of care to high-risk, impoverished populations need to develop strong links to mental health, substance abuse, and family preservation services that allow them to intervene with troubled women and their families with services that are alternatives to incarceration and punitive actions.     

Mothers' attitudes toward seeking help for their children from school and private psychologists.

What inhibits parents from seeking psychological help for their children? This study examined the attitudes of mothers of school-age children toward seeking psychological help from school psychological services and from private psychologists. Mothers express greater and more intense worries in relation to seeking help from school psychological services as compared to private psychologists. Hypothetical vignettes about a problematic child also showed that mothers prefer to refer both their own child and that of a friend to a private psychologist. Reducing the threat aroused by public sector psychologists should increase the utilization of psychological help for children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control

OBJECTIVES: This study examined how immunization-related beliefs, attitudes, and perceived control mediate up-to-date immunization among various sociodemographic groups. METHODS: Statewide estimates of immunization rates among children up to the age of 2 years were obtained via a multistage cluster sample. In-person interviews were conducted with 4832 parents. Information about immunization was obtained from official records or from health care providers. RESULTS: Differences in immunization among sociodemographic groups were mediated by beliefs about objective barriers to immunization, protection, medical contraindication, safety concerns, distrust, and natural immunity. Protection beliefs contributed to positive attitudes toward immunization; beliefs in natural immunity and safety concerns contributed to negative attitudes. Beliefs about objective barriers, distrust, safety concerns, and medical contraindications influenced perceived control over immunization. Positive attitudes and a strong sense of control contributed to higher immunization rates. CONCLUSION: These findings provide a basis for efficient educational campaigns by specifying which beliefs should be bolstered (because they facilitate proper immunization) and which should be targeted for change (because they hinder proper immunization) in various sociodemographic groups.