Children’s Adjustment and Child Mental Health Service Use: The Role of Parents’ Attitudes and Personal Service Use in an Upper Middle Class Sample

Forty-one parents and their children (20 girls and 21 boys, mean age = 4.33 years, SD = 1.30) participated in a study to examine how parents’ personal use of mental health services related to their attitudes toward child mental health services as well as to their children’s adjustment. Results indicated that parents’ attitudes and personal use of services have implications for children’s adjustment and mental health utilization. Parents who personally used mental health services reported more positive help-seeking attitudes, higher level of help-seeking intentions, and lower stigmatization of child mental health services. In addition, parents who used child services in the past reported higher levels of internalizing (not externalizing) behaviors in their children, and parents’ previous experience predicted child mental health service use. Results have implications for fostering positive attitudes and reducing stigma about child mental health services that may prevent parents from seeking professional help for their children.     

Methodological Challenges in Assessing Children's Mental Health Services Utilization

This paper describes the reliability and validity of the service assessment for children and adolescents (SACA) for use among Spanish-speaking respondents. The test-retest reliability of the instrument was assessed in a randomly selected clinical sample of 146 Puerto Rican children and adolescents aged 4–17. Both parents and children were administered the SACA twice by independent interviewers over an average 12-day follow-up period. The accuracy of parental and youth self-reports was assessed by comparing these reports to information obtained from medical records. The results showed that parents and children (aged 11–17) were able to report with fair to moderate reliability any last year use of mental health services, any outpatient mental health services, and school services. Residential and hospitalization services were reported by both informants with substantial test-retest reliability. Slight or no test-retest reliability was obtained for parent and child on the use of the specific type of mental health professionals, as well as parental reports of several treatment modalities. Substantial sensitivity of the SACA was obtained when comparing medical records to parental and child reports to lifetime use of any service and outpatient mental health service. Moderate sensitivity was obtained for last year use of mental health services for both parent and child informants.     

Factors Influencing Perceptions of Need for and Decisions to Solicit Child Mental Health Services by Parents of 9–12 Year-Old Korean Children

As children with emotional or behavioral problems often fail to receive the treatment available to them, this study examined (1) the degree of perceived need (PN) among Korean parents regarding mental health services for their children, (2) the factors associated with such perceptions, (3) the degree to which Korean parents actually engage mental health services for their children, and (4) the factors associated with such use. To determine the degrees of PN and actual use, 1,058 children aged between 9 and 12 years were asked to complete the Children’s Depression Inventory, while their parents completed the Child Behavior Checklist. About 11.4% of the parents demonstrated PN, compared to 2.7% who actually engaged child mental health services. While most of the CBCL factors were associated with PN, the child’s self-report significantly affected the perception as well. The attention problem score in the CBCL was the only factor that strongly corresponded to the actual use of services in Korea, a country where academic achievement is considered paramount, which suggests that cultural forces may play a powerful role in determining parents’ decisions regarding child mental health care.     

Need for and use of mental health services among parents of children in the head start program

This study examined the prevalence of psychosocial difficulties and use of mental health services among 290 parents of children in the Head Start program. Data on demographic characteristics, child behavior problems, parents' difficulties, home environment, child behavior, and use of health services were collected. A total of 161 parents (56 percent) had identifiable psychosocial difficulties, and 41 (14 percent) reported use of mental health services in the previous 12 months. Child behavior problems, unmet need for mental and physical health services, and less optimal home environments were associated with parents' psychosocial difficulties. Parents who had an unmet need for mental health services were more likely to report behavior problems among their children.     

Post-9/11 helpseeking by New York City parents on behalf of highly exposed young children

This study examines factors related to helpseeking among New York City parents on behalf of their young children after the September 11th terrorist attacks. Data were gathered from 180 parents about their children (under age 5) through in-depth parent interviews 9-12 months postdisaster. Parents were asked to describe their children's disaster-related experiences, their own and their children's mental health status, and post-9/11 helpseeking behavior for their children. Predictors of parental helpseeking for children's services included the emergence of new fears in children since 9/11, parent symptoms of depression, and parents' own helpseeking. The strongest predictor was children's direct exposure to the attacks. Fifteen percent (n = 27) of parents sought services for their very young children. Findings suggest that following 9/11, a familial orientation to helpseeking combined with children's specific disaster-related experiences may provide a basis for seeking services for young children, rather than children's apparent mental health status.     

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.     

A qualitative exploration of child clinical psychologists' understanding of user involvement

'Service User Involvement' is a key directive for mental health services. This is thought to be especially complex in child services-despite evidence that it can be achieved-because of the need to use developmentally-appropriate tools. Children are in a multi-faceted position of disempowerment when they enter mental health services; attempts to involve them in these services are entangled with intricate power issues. To explore these issues, eight Clinical Psychologists who work with children were interviewed about their views and experiences of User Involvement. Their accounts were analysed by drawing on Foucauldian Discourse Analysis. The resulting account demonstrates how children are consistently positioned as both vulnerable and powerless (in contrast to parents and professionals). This has the effect of rendering them as less-than-ideal candidates for involvement in service evaluation and planning, in a context where parents may seem to offer a more straightforward option to professionals, and where those professionals see themselves as having to operate within certain constraints.     

Vietnamese parental perceptions of child and adolescent mental illness.

OBJECTIVES: To determine the symptoms and behaviors in children which are considered psychopathological by Vietnamese parents, to identify professionals and agencies in the community whom Vietnamese parents would consult if their child had a mental illness, and to determine Vietnamese parents' awareness of existing community mental health services. METHOD: Structured interviews were conducted with a randomized community sample of 283 Vietnamese parents in Perth, Australia. Parents were asked to identify the symptoms and behaviors they considered psychopathological in children, where they would turn for help with a mentally ill child, their knowledge of community mental health services for children, and their understanding of the causes of child psychiatric disorders. RESULTS: Vietnamese parents identified psychotic symptoms, disorientation, and suicidal thoughts and behavior as psychopathological. They preferentially endorsed Western-style treatment approaches but had little awareness of existing community mental health services for children. A biological/chemical imbalance, traumatic experiences, and a metaphysical/spiritual imbalance were identified as the most likely causes of child mental illness. CONCLUSIONS: Despite a different cultural tradition, Vietnamese parents appear open to services provided by Western-trained mental health professionals. Their very limited awareness of child and adolescent mental health services in the community, however, may severely limit their utilization of such services.     

Parent's perceptions of their first graders' need for mental health and educational services

OBJECTIVES: (1) To estimate the proportion of first graders perceived by their parents as needing mental health or educational services, (2) to examine the validity of these perceptions, and (3) to examine whether factors found to be associated with children's referral to or use of services are associated with parental perceptions. METHOD: Subjects are an epidemiological sample of 467 first graders. Children's social adaptational status and psychological well-being were assessed by multiple methods. Logistic regression was used to investigate the associations between indicators of need and parental perceptions of their children's need for services. RESULTS: More than 39% of the children were perceived by their parents as needing services. Predictors of parents perceiving their children as needing services were parent and teacher ratings of children's behavior and symptoms, children's standardized achievement test scores, and gender. CONCLUSIONS: Given that a large proportion of parents reported their children as needing mental health and educational services and that parents play a central role in children's receiving services, longitudinal studies that investigate the entire process by which children enter into and are maintained in the service delivery system are needed.     

Seeking help a second time: parents'/caregivers' characterizations of previous experiences with mental health services for their children and perceptions of barriers to future use

This study examines the relationship between urban parents'/caregivers' previous experiences obtaining mental health care for their children and their perceptions of barriers to their children's use of services in the future. Assessments of prior treatment outcome and aspects of relationships with former providers were linked to endorsements of doubt about the utility of treatment as a potential barrier to the children's use of services in the future and the number of barriers parents endorsed. Implications for urban child mental health service delivery are drawn.     

What do children and young people want from mental health services?

PURPOSE OF REVIEW: The purpose of this paper is to review the literature reporting on children and young people's views on child and adolescent mental health services. RECENT FINDINGS: The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them. SUMMARY: To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.     

Reliability of the services assessment for children and adolescents

OBJECTIVE: This study examined the test-retest reliability of a new instrument, the Services Assessment for Children and Adolescents (SACA), for children's use of mental health services. METHODS: A cross-sectional survey was undertaken at two sites. The St. Louis site used a volunteer sample recruited from mental health clinics and local schools. The Ventura County, California, site used a double-blind, community-based sample seeded with cases of service-using children. Participating families completed the SACA and were retested within four to 14 days. The reliability of service use items was calculated with use of the kappa statistic. RESULTS: The SACA- Parent Version had excellent test-retest reliability for both lifetime service use and previous 12-month use. The SACA also had good to excellent reliability when administered to children aged 11 and older for lifetime and 12-month use. Reliability figures for children aged nine and ten years were considerably lower for lifetime and 12-month use. The younger children's responses suggested that they were confused about some questions. CONCLUSIONS: This study demonstrates that parents and older children can reliably report use of mental health services by using the SACA. The SACA can be used to collect currently unavailable information about use of mental health services.     

Perceived Need and Use of Child Mental Health Services in Korea

This study examined the degree of perceived need and use of child mental health services in Korea, as well as the factors associated therewith. The sample consisted of 3,477 children aged 8–13 years. Overall, 10.4% of the parents demonstrated a perceived need for mental health services regarding their children’s emotional or behavioral problems, while 1.9% used mental health services. Although the perceived need for mental health services is high, only a small proportion of children receive them. Whether a child receives mental health care is influenced by the child’s psychopathology, especially when social and/or thought problems exist.     

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.     

What is a Mental Health Clinic? How to ask Parents about Help-seeking Contacts Within the Mental Health System

We compared parents' endorsement of having contacted a "mental health clinic or agency" when seeking help for their child, with parents' recognition of having contacted specific, named mental health agencies in their geographic region. Data were from two studies involving parents of children and adolescents seeking mental health services. Across the two studies, only 28 and 41% of parents reported having contacted a "mental health agency," but 100% reported contact when asked about specific agencies by name. Incorporating this simple modification in future studies could provide more accurate documentation of help-seeking for, and utilization of, children's mental health services.     

Mental health screening of preschool children: validity and reliability of ABLE

Children with behavioral, emotional or language problems struggle to do well at school often with limited success. ABLE (Attention, Behavior, Language, and Emotions), a new screening tool, was used to estimate the prevalence and the severity of concerns parents and teachers have about children's school adjustment and evaluate their need for services. Data obtained from the parents and teachers of children randomly selected from public Pre-K classrooms in 6 states (N = 415) and from a mental health screening of rural and urban children (N = 5,577) support the validity and reliability of ABLE. Parents identified severe problems in 18.4% of children and Pre-K teachers identified 10.5%. By kindergarten, the proportion of children identified by their teachers with serious problems more than doubled to 23%. Inattention/overactivity and behavior problems were identified most often. These children were 3.4 times more likely to be certified later for special education services by kindergarten than children not identified with problems by ABLE. However, fewer than 14% of children in public Pre-K identified with serious problems in Pre-K had received mental health services by the end of Kindergarten.     

Behavioral disorders in pediatric epilepsy: unmet psychiatric need

PURPOSE: This study examined the relation between psychiatric diagnosis and mental health services in children with epilepsy and the associated demographic, cognitive, linguistic, behavioral, and seizure-related variables. METHODS: The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Child Behavior Checklist, the Test of Language Development, and the Wechsler Intelligence Scale for Children-Revised (WISC-R) were administered to 114 children, aged 5 to 16 years, with either complex partial seizures (CPS) or primary generalized with absence (PGE, petit mal). A Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis and information regarding mental health services were derived from the K-SADS. RESULTS: Although approximately 60% of the subjects had a DSM-IV psychiatric diagnosis, >60% received no mental health treatment. Absence of mental health care was associated with younger age, less parental education, limited number of antiepileptic drugs (AEDs; i.e., one or none), and higher verbal IQ. In addition, children with PGE and a single psychiatric diagnosis were less likely to have a history of mental health treatment. CONCLUSIONS: This is the first study to demonstrate unmet mental health need in a large sample of children with CPS and PGE. The study's findings suggest that parents and clinicians should be aware of the mental health needs of children with epilepsy, particularly if they have one or more of the identified risk factors.     

School-Based Mental Health Services for Children Living in High Poverty Urban Communities

Studied the effectiveness of a school-based mental health service model, PALS (Positive Attitudes toward Learning in School), focused on increasing initial and ongoing access to services, and promoting improved classroom and home behavior for children referred for Disruptive Behavior Disorder (DBD) from three high poverty urban elementary schools. Classrooms were randomly assigned to PALS or referral to a neighborhood mental health clinic, with children identified by teacher referral and follow-up parent andeher ratings. Results indicated significant service engagement and retention for PALS (n=60) versus families referred to clinic (n=30), with over 80% of PALS families retained in services for 12 months. PALS services were correlated with positive changes in children's behavior as rated by parents, and with improvements in children's academic performance as rated by teachers. Implications for the design and delivery of mental health services for children and families living in high-poverty urban communities are discussed.     

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.