Mental health literacy,treatment preferences,and barriers in Salvadorian parents

Parents are pivotal in accessing treatment for their children, yet we know little about youth mental health literacy in parents. This is particularly the case in developing countries such as El Salvador, where good parent mental health literacy about children’s psychological problems may play a pivotal role in being able to navigate treatment access in an already underfunded and poorly resourced system. This study examined parent mental health literacy about child anxiety disorders in El Salvador; parent perceptions and preferences for treatment-seeking; and perceived barriers to accessing mental health treatment. Parents (N?=?271) of youth aged 4–17 in El Salvador answered questions about three vignettes depicting different childhood anxiety disorders. The majority of parents did not recognize specific youth anxiety disorders. Less than 5% of parents identified the vignettes as a mental health problem, most commonly attributing symptoms to personal weakness or stress. Parents endorsed generally positive views about seeking treatment, preferring non-pharmacological mental health treatments, informal support from grandparents and religious leaders, and handling the problem personally. The most common barriers to treatment-seeking were related to cost and service availability. Improving parent mental health literacy may assist with treatment-seeking. Results have implications for mental health policy decisions and service implementation in El Salvador.     

Identifying adolescents at risk through voluntary school-based mental health screening

This study compares referrals for mental health services among high school students randomized to two means of referral to mental health services: referral via systematic identification through a brief mental health screening procedure (n = 365) or referral via the usual process of identification by school personnel, parents, or students themselves (n = 291). Screened students were significantly more likely than control students (AOR: 21.64 95%CI 6.66-70.36) to receive a referral for mental health services, whether it be to school-based services (AOR: 11.68 95%CI 3.52-8.73) or community-based services (AOR: 20.02 95%CI 2.66-150.41). Post-study, for those screened, 95.5% of school-based mental health services referrals, and 39.3% of community-based referrals were accessed. School based mental health screening identified a significantly greater proportion of youth to be in clinical need of mental health services than would have likely been identified without screening, and increased rates of referral resulted in greater access to mental health services.     

The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study

Background  

Australia's public access residential early parenting services provide programs to assist parents who self-refer, to care for their infants and young children. Treatment programs target infant feeding and sleeping difficulties and maternal mental health. There is limited systematic evidence of maternal and infant mental health, psychosocial circumstances or presenting problems, or the effectiveness of the programs. The aim of this study was to contribute to the evidence base about residential early parenting services.     

Determinants of mental health service use among depressed adolescents

Objective

Evaluate determinants of mental health service use among depressed adolescents.

Method

We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥ 11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use.

Results

Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77–16.35), parental history of depression/anxiety (OR 4.12, CI 1.36–12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use.

Conclusion

Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.     

Factors associated with mental health service utilization among bipolar youth

OBJECTIVES: This study aims to characterize patterns of mental health service utilization within a sample of bipolar youth. Demographic variables, youth bipolar characteristics, youth comorbid conditions, and parental psychopathology were examined as predictors of treatment utilization across different levels of care. METHODS: A total of 293 bipolar youth (aged 7-17 years) and their parents completed a diagnostic interview, family psychiatric history measures, and an assessment of mental health service utilization. Demographic and clinical variables were measured at baseline and mental health service use was measured at the six-month follow-up. RESULTS: Approximately 80% of bipolar youth attended psychosocial treatment services over the span of 6 months. Of those who attended treatment, 67% attended only outpatient services, 22% received inpatient/partial hospitalization, and 12% received residential/therapeutic school-based services. Using multinomial logistic regression, older age, female gender, and bipolar characteristics, including greater symptom severity and rapid cycling, were found to predict higher levels of care. Youth suicidal and non-suicidal self-injurious behavior, comorbid conduct disorder, and parental substance use disorders also predicted use of more restrictive treatment settings. CONCLUSIONS: Results underscore the importance of assessing for and addressing suicidality, comorbid conduct disorder, and parental substance use disorders early in the treatment of bipolar youth to potentially reduce the need for more restrictive levels of care.     

School Mental Health and Foster Care: A Logical Partnership

School mental health is increasingly recognized as an effective framework of care for enhancing access to high quality mental health services for school age youth. This article discusses the potential role that school mental health can play in helping to address the mental health needs of children and adolescents in foster care, a group with elevated risk for mental health and educational problems when compared to other children and adolescents living in high risk environments. A full continuum of school mental health services, from prevention to intervention, offers opportunities to reach these youth before academic and emotional-behavioral problems escalate. Benefits and challenges to providing services to youth in foster care through school mental health are discussed and next steps toward developing a training curriculum that addresses core competencies needed for effective school-mental health-foster care integration are addressed.     

Patients' perception of possible child custody or visitation loss for nonadherence to psychiatric treatment

OBJECTIVE: This study explored whether parents treated in public mental health settings perceived that they might lose child custody or visitation if they were not adherent to treatment. METHODS: Interview data were gathered from 1,011 adult outpatients from five community mental health centers located in five states in different U.S. regions. RESULTS: Among parents with children younger than 16 (N=187), 19% perceived in the past six months that they might lose child custody or visitation if they were not adherent to treatment. Two-thirds of the identified sources of this perception were family, themselves, or individuals outside the treatment, welfare, or legal systems. CONCLUSIONS: These preliminary data indicate that the perception of possible loss of child custody or visitation for nonadherence to treatment is not uncommon among patients treated in these public mental health settings and that "informal" sources are often the perceived source. Further study regarding the effects of this perception on patient and family outcomes is needed.     

Predicting parents’ intentions to seek help for young children’s mental health

One in five school-age children has mental health problems, yet less than a quarter access professional help. Early childhood presents a window for prevention. This study implemented the ‘Theory of Planned Behaviour’ to explore parents’ intentions to seek professional help for young children’s behaviour and emotional problems. Participants were 442 parents of 6-year-old children, recruited as a population sample in infancy. The ‘Theory of Planned Behaviour’ measured parents’ personal intentions, attitudes and beliefs about seeking professional help for young children’s mental health. Although many parents (84%) had positive intentions to seek help if their young child were in need, a proportion (16%) was ambivalent/unlikely to do so. Specific beliefs distinguishing parents with positive intentions were that professionals would provide expert strategies with empathy and understanding, with appointments providing value for time and money. Community mental health initiatives could target these beliefs in facilitating better access for young children in need.     

Violent and aggressive behaviors in youth: a mental health and prevention perspective

Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.     

Youth and Caregiver Access to Peer Advocates and Satisfaction with Mental Health Services

Access to peer advocates is increasingly available to youth and their caregivers who are receiving services in the public mental health system. This study examines associations between reported access to a youth or family advocate and perceptions of satisfaction with mental health services. A cross-sectional survey of youth (N = 768) and caregivers (N = 1,231) who utilized public mental health services in New York State in 2012 was conducted. The survey includes items on access to youth or family advocates and degree of satisfaction with mental health services. A greater proportion of youth or caregivers with access to peer advocates compared to those without access responded positively on the satisfaction domains of access to services, appropriateness of services, participation in services and overall/global satisfaction. Access to peer advocates was also positively associated with agreement on the psychotropic medication comprehension domain for youth and on perceptions of child functioning and social connectedness for caregivers compared to those without access. This study adds to the growing understanding of the important role peer advocates play in engaging youth with mental health needs and their caregivers in mental health services.     

Identification of Youth Psychosocial Problems During Pediatric Primary Care Visits

This investigation applied the Gateway Provider Model (GPM) of child mental health services to investigate whether characteristics of the child, family, visit, and provider were related to the identification of youth psychosocial problems during primary care visits. Data were gathered during 774 visits to 54 primary care providers (PCPs) at 13 clinics. Similar to previous investigations in primary care settings, 42% of youth demonstrated at least a sub-threshold clinical mental health problem. Most PCPs reported high job satisfaction and control, but reported varying access to mental health specialists. PCPs generally had positive attitudes and beliefs about treating psychosocial problems but many reported that doing so was burdensome. Identification was more likely when the visit was for a mental health problem, when issues related to psychosocial problems were discussed during the visit, when the youth demonstrated mental health symptoms, impairment, or burden to the family, and when the youth was older, uninsured, or received Medicaid. Identification was less likely when the PCP reported greater burden associated with treating psychosocial problems and when the PCP reported greater accessibility to mental health specialists. These results suggest that identification is associated with the interaction of multilevel factors and that the GPM is a useful model to investigate points of intervention for improving the identification of children’s mental health problems in primary care settings. Presented in part at the University of South Florida 18th Annual Research Conference: A System of Care for Children’s Mental Health, Tampa, FL, February 2006.     

Psychiatric disorder,impairment, and service use in rural African American and white youth

BACKGROUND: The Caring for Children in the Community Study examined the prevalence of DSM-IV psychiatric disorders and correlates of mental health service use in rural African American and white youth. METHODS: Four thousand five hundred youth aged 9 to 17 years from 4 North Carolina counties were randomly selected from school databases. Parents completed telephone questionnaires about their children's behavior problems. A second-stage sample of 1302 was identified for recruitment into the interview phase of the study, and 920 (70.7%) of these were successfully interviewed at home using the Child and Adolescent Psychiatric Assessment and related measures of service use. RESULTS: Weighted back to general population estimates, 21.1% of youth had 1 or more DSM-IV psychiatric disorders in the past 3 months. Prevalence was similar in African American (20.5%) and white (21.9%) youth. The only ethnic difference was an excess of depressive disorders in white youth (4.6% vs 1.4%). Thirteen percent of participants (36.0% of those with a diagnosis) received mental health care in the past 3 months. White youth were more likely than African American youth to use specialty mental health services (6.1% vs 3.2%), but services provided by schools showed very little ethnic disparity (8.6% vs 9.2%). The effect of children's symptoms on their parents was the strongest correlate of specialty mental health care. CONCLUSIONS: In this rural sample, African American and white youth were equally likely to have psychiatric disorders, but African Americans were less likely to use specialty mental health services. School services provided care to the largest number of youths of both ethnic groups.     

Mental Health and Substance Abuse Services to Parents of Children Involved with Child Welfare: A Study of Racial and Ethnic Differences for American Indian Parents

American Indian (AI) parents of children involved with child welfare were compared to White, Black and Hispanic parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0–14 years involved with child welfare. Weighted statistics provided population estimates, and multivariate logistic regression was used to predict the likelihood of caregivers receiving mental health or substance abuse services. There were significant disparities in the likelihood of receiving mental health, but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in this study. AI parents fared the worst in obtaining mental health treatment. Parents of children at home and of older children were less likely to access mental health or substance abuse treatment.     

Violent and Aggressive Behaviors in Youth: A Mental Health and Prevention Perspective

Abstract

Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.     

The link between ethnicity,social disadvantage and mental health problems in a school-based multiethnic sample of children in the Netherlands

To investigate to what extent differences in prevalence and types of mental health problems between ethnic minority and majority youth can be explained by social disadvantage. Mental health problems were assessed in a sample of 1,278 schoolchildren (55 % Dutch, 32 % Moroccan and 13 % Turkish; mean age: 12.9 ± 1.8) using the Strengths and Difficulties Questionnaire self-report and teacher report. Measures of family socioeconomic status, neighbourhood deprivation, perceived discrimination, family structure, repeating a school year, housing stability and neighbourhood urbanization were used as indicators of social disadvantage, based on which a cumulative index was created. Ethnic minority youth had more externalizing and fewer internalizing problems than majority youth. Perceived discrimination and living in an unstable social environment were associated with mental health problems, independent of ethnicity. A dose–response relationship was found between social disadvantage and mental health problems. The adjusted odds ratio for mental health problems was 4.16 (95 % CI 2.49–6.94) for more than four compared with zero indicators of social disadvantage. Social disadvantage was more common in ethnic minority than in majority youth, explaining part of the differences in prevalence of mental health problems. Ethnic minority youth in the Netherlands have a different profile of mental health problems than majority youth. In all ethnic groups, the risk of mental health problems increases with the degree of social disadvantage. The higher prevalence of externalizing problems among ethnic minority youth is explained partly by their disadvantaged social position. The findings suggest that social factors associated with ethnicity are likely to explain mental health problems in ethnic groups.     

Parent–youth discrepancy in the assessment and treatment of youth in usual clinical care setting: consequences to parent involvement

Background Involving parents in the treatment of youth referred for mental health problems is an important agenda. Parent involvement is associated with treatment retention, greater family participation, and positive outcomes. The main goal of the present study was to examine the role of youth and parent report of the youth’s psychopathology and interpersonal problems on parent involvement in outpatient treatment of the youth. Methods Data were gathered from 63 referred youth in treatment in an outpatient clinic. Subjects reported the youth’s interpersonal problems and problem syndromes. The direct account of the youth and parents was examined for association with two indices of parent involvement, namely, the mothers’ behavioral involvement (BI) and personal emotional involvement (PEI) in the treatment process. Results Results showed that while direct reports of the youth and parents were not significant predictors of parent involvement, discrepancy scores predicted parent involvement. Further, there were twice as many scales of interpersonal problems that were related to parent involvement as the syndrome scales. Conclusion The ability of discrepancy scores in predicting parent involvement underscores that it is not only a risk factor for later development of adverse outcomes, but also related with essential treatment processes. Clinicians may be able to address these issues and aid in treatment processes leading to desired outcomes.     

Neighbourhood context and diagnosed mental health conditions among immigrant and non-immigrant youth: a population-based cohort study in British Columbia,Canada

Purpose

Evidence from systematic reviews suggests that adult immigrants living in areas of higher immigrant density (areas with a higher proportion of foreign-born residents) tend to experience fewer mental health problems—likely through less discrimination, greater access to culturally/linguistically appropriate services, and greater social support. Less is known about how such contexts are associated with mental health during childhood—a key period in the onset and development of many mental health challenges. This study examined associations between neighbourhood immigrant density and youth mental health conditions in British Columbia (BC; Canada).

Methods

Census-derived neighbourhood characteristics were linked to medical records for youth present in ten of BC’s largest school districts from age 5 through 19 over the study period (1995–2016; n = 138,090). Occurrence of physician assessed diagnoses of mood and/or anxiety disorders, attention deficit hyperactivity disorder (ADHD), and conduct disorder was inferred through International Classification of Diseases (ICD) diagnostic codes in universal public health insurance records. Multi-level logistic regression was used to model associations between neighbourhood characteristics and odds of diagnoses for each condition; models were stratified by generation status (first-generation: foreign-born; second-generation: Canadian-born to a foreign-born parent; non-immigrant).

Results

Higher neighbourhood immigrant density was associated with lower odds of disorders among first-generation immigrant youth (e.g., adjusted odds of mood-anxiety disorders for those in neighbourhoods with the highest immigrant density were 0.67 times lower (95% CI: 0.49, 0.92) than those in neighbourhoods with the lowest immigrant density). Such protective associations generally extended to second-generation and non-immigrant youth, but were—for some disorders—stronger for first-generation than second-generation or non-immigrant youth.

Conclusions

Findings suggest there may be protective mechanisms associated with higher neighbourhood immigrant density for mental health conditions in immigrant and non-immigrant youth. It is important that future work examines potential pathways by which contextual factors impact immigrant and non-immigrant youth mental health.

     

Barriers and Enablers to Accessing Mental Health Services for People With Intellectual Disability: A Scoping Review

Background: It is well established that people with an intellectual disability have high rates of mental health problems, yet rates of uptake of services do not match need. Aim: To identify the current literature pertaining to the barriers and facilitators to access to mental health services for people with an intellectual disability. Method: A systematic search identified English-language articles that addressed barriers or enablers to access, mental health services, and intellectual disability from 2005 to 2016. Results were synthesized according to Gulliford et al.’s four dimensions of access: availability, utilization, relevance and effectiveness, and equity. Results: Barriers and enablers were identified across all the dimensions. Organizational barriers, lack of services, and poor-quality services related to deficits in knowledge were among the barriers discussed in the literature. Facilitators included emphasis on interagency collaboration, and training and education. Substantial gaps were also identified, particularly in relation to the lived experience of these barriers. Conclusions: Further research and evaluation across all aspects of access to mental health care for people with an intellectual disability is needed.     

Responding to students with posttraumatic stress disorder in schools

The prevalence of trauma exposure among youth is a major public health concern. Students who have experienced a traumatic event are at increased risk for academic, social, and emotional problems. School can be an ideal setting for mental health professionals to intervene with traumatized students, school staff, and parents both immediately following a traumatic event and when symptoms of posttraumatic stress disorder and other trauma-related mental health problems develop. This article describes evidence-based treatments for posttraumatic stress disorder and outlines practical approaches to use in schools.     

Racial/Ethnic Differences in Caregiver Strain and Perceived Social Support Among Parents of Youth with Emotional and Behavioral Problems

This study examined several hypotheses related to racial/ethnic variations in caregiver strain and perceived social support among parents caring for children with emotional/behavioral problems. A subsample of youth from the Patterns of Care (POC) study, which drew a stratified random sample of high-risk youth active to 1 of 5 public sectors of care, was used to test these hypotheses. When controlling for youth age, parental education, presence in an alcohol/drug or mental health (ADM) sector, and severity of child problems, African Americans reported significantly lower caregiver strain then did non-Hispanic Whites (NHWs), whereas Asian/Pacific Islanders (APIs) and Latinos did not differ significantly from NHWs. Contrary to prediction, both African Americans and APIs reported significantly lower perceived social support than NHWs, whereas Latinos did not differ significantly from NHWs. When perceived social support was controlled, the tendency of African American and API parents to report lower caregiver strain than NHWs became more pronounced. Thus, differences in perceived social support did not explain African Americans' lower caregiver strain. Other cultural variables such as familism and tolerance should be examined to identify processes that result in reduced perception of caregiver strain among African American parents caring for children with emotional/behavioral problems.