How Parents Seek Help for Children with Mental Health Problems

"I had no idea there were psychiatric clinics for children": A qualitative study of how migrant parents reach Swedish mental health services for their children

Migrant children have repeatedly been shown to underutilize psychiatric services and to face barriers to care, yet few studies have examined the experience of migrant parents who are successful in their help-seeking efforts for their children's mental health. The aim of this study was to gain a deeper understanding of facilitators and obstacles to reaching care among migrant parents in contact with child psychiatric services. We explored how migrant parents in Stockholm, Sweden, experienced the process of reaching child mental health services. Participants were recruited from out-patient mental health clinics. Ten in-depth interviews were conducted; qualitative analysis of transcripts was undertaken using thematic content analysis. Parents described a desire to reach services but difficulties doing so on their own. We identified a strong dependence on referring agents, such as schools and child health centers, for parents to gain contact. Informants expressed a high degree of trust toward these agents. Contrary to previous studies, stigma was not described as an obstacle to help-seeking but was recognized by informants as a potential barrier to care had they not emigrated. Although participants in our study had differing educational backgrounds and residency times in Sweden, a common experience of reliance on others for reaching services was evident in the data. Our findings highlight the role of referring agents as bridging contacts between different welfare services. Understanding the specific local resources and services that are available to migrant parents, and strengthening these across different sectors, could potentially help reduce barriers to care.

Parents' experience and views on the assessment and treatment of children with OCD within the public mental health system in Iceland: a qualitative study

PURPOSE

Obsessive-compulsive disorder (OCD) in children can lead to long-lasting symptoms and access to evidence-based evaluation and treatment is crucial for its prevention. In Iceland, the law guarantees public access to the highest quality healthcare services. To date, no study has evaluated the services available for children with OCD within the national healthcare system (NMHS). This qualitative study explored the experiences of parents navigating the Icelandic NMHS for their children with OCD.

METHOD AND MATERIALS

Seven parents who had sought services within the NMHS for their children diagnosed with OCD at private clinics were interviewed using a semi-structured interview. The responses were analyzed using thematic framework analysis.

RESULTS

Nineteen themes were identified, including three overarching themes and eight overarching sub-themes, and eight sub-themes within them. A prevalent theme was the giving up on the national mental healthcare system due to parents' experiences of accessing mental healthcare for their children being challenging. Other issues faced by parents included a lack of knowledge on where to seek help, inadequate evaluation of the issue, and the lack of access to psychotherapy for their children. The healthcare workers' responses and recommendations also resulted in parents seeking treatment at private clinics.

CONCLUSIONS

These findings underscore the need for clearer pathways for seeking help, improved access to trained healthcare workers, and a more centralized evaluation process. These insights can potentially guide future research and policy decisions to better support families dealing with childhood OCD in Iceland.

A Qualitative Exploration of Ontario Caregivers' Perspectives of Their Role in Navigating Mental Health and/or Addiction Services for Their Youth

Many youth experiencing mental health and/or addiction (MHA) concerns rely on their caregivers to find and access services. Considering that caregivers often play a significant role in their youth's treatment trajectory, a descriptive qualitative study was used to explore how caregivers (n = 26) in the Greater Toronto Area perceive their role in navigating MHA care for their youth (ages 13 to 26). The Person-Environment-Occupation model was used to guide the thematic analysis. The findings reveal three main themes (1) the internal experience of caregiving, which describes caregivers' emotions and thought processes; (2) the external factors impacting the caregiver's ability to find and access youth MHA services, which explores systemic and social factors that impact navigation; and (3) the demands of the caregiving role. The discussion highlights the importance of supporting the wellbeing of caregivers as they navigate youth MHA services and can provide useful information for healthcare professionals and policy-makers to increase equitable access to youth MHA services.

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators

INTRODUCTION

Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care.

METHODS

This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking).

RESULTS

A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced.

CONCLUSION

This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.

The Longitudinal Youth in Transition Study (LYiTS) Cohort Profile: Exploration by Hospital- Versus Community-Based Mental Health Services

OBJECTIVES

Youth face numerous challenges in receiving coordinated and continuous mental health services, particularly as they reach the age of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). The Longitudinal Youth in Transition Study (LYiTS) follows youth prospectively as they cross this transition boundary to better understand their transition pathways and resulting symptoms and health service use outcomes. The current paper presents the baseline profile description for the LYiTS cohort and additionally examines differences in symptoms and functioning and health service utilization between youth receiving services at hospital- versus community-based CAMHS.

METHODS

A cross-sectional design was used. A sample of 237 16-18-year-old youth recruited from outpatient CAMHS at two hospitals and two community sites completed self-report measures at their first of four annual assessments. A latent profile analysis was conducted to identify symptomology profiles, and youth were compared on symptoms and health service use between hospital- and community-based sites.

RESULTS

Four distinct symptomology profiles were identified (subclinical, moderate internalizing, moderate externalizing, and high symptomology). Symptom profiles and functioning levels reported by youth were no different across both types of organization, although there were differences detected in health service utilization, such as type of provider seen and use of medications.

CONCLUSIONS

These findings suggest that there is little difference in symptomology between youth accessing hospital versus community-based CAMHS. With growing interest in understanding the effectiveness and cost-effectiveness of different models of mental health care, these findings provide a new understanding of the clinical and service use profiles of transition-aged youth that will be explored further as this cohort is followed across the CAMHS to AMHS transition boundary.

A Digital Mental Health Intervention for Children and Parents Using a User-Centred Design

The number of children with mental health problems is ever-growing; as a result, nearly 850,000 children in the UK are believed to have clinically significant problems, and only a quarter show evidence of mental illness. Family members often have a hard time dealing with children with mental health problems. As a result, digital mental health interventions are becoming popular for people seeking professional mental health services. Previous studies in this area have also shown that parents who are divorced or working away from home struggle to maintain contact with their children. This lack of communication between the parents and their children can worsen the children’s mental health conditions and prevent early diagnosis. Human-centred design thinking is applied step by step in this paper to provide an intuitive understanding of the design process. Five stages of the design thinking process were examined to follow a correct path. The results were promising, and the feedback received assured that the product helps parents to better monitor their children’s mental health and provides support when needed. The design thinking process was followed in concordance with the user needs identified from previous studies in this area, which led to a working solution that benefits both parents and children in tackling these problems.

Parents’ and Teachers’ Knowledge of Trauma and Post-Traumatic Stress Disorder in Children and Adolescents and Their Agreement Towards Screening

Background

Trauma exposure is common in children and adolescents. Parents and other key adults, such as teachers, are necessary to facilitate help-seeking behavior, which involves recognizing trauma and adverse reactions and awareness of accessing treatments. Where screening measures in schools are used to detect post-traumatic stress disorder (PTSD), the attitudes of parents and teachers towards screening need to be considered.

Objective

To examine whether parents and teachers can accurately detect trauma events, symptoms and effective treatments. In addition, to assess how supportive parents and teachers are towards PTSD screening in schools.

Method

A total of 439 parents and 279 teachers completed online questionnaires assessing PTSD knowledge across three domains: traumatic events, PTSD symptoms and evidence-based treatments. Responses of acceptability of using PTSD screening tools in schools were elicited.

Results

Teachers and parents were accurate in recognizing trauma events and PTSD symptoms. However, understanding was inclusive, with events not considered traumatic and non-PTSD diagnostic criteria being endorsed. Trauma-Focussed Cognitive-Behavioral Therapy was recognized as an effective treatment for PTSD, but Eye-Movement Desensitization and Reprocessing was not. Treatments not recommended by health guidelines were frequently endorsed. The majority of participants were supportive of PTSD screening in schools, but a minority were not.

Conclusions

Parents and teachers are able to recognize trauma events and symptoms of PTSD, although this tends to be overly inclusive. Schools could be targeted to promote understanding trauma among parents and teachers. Agreement with screening is encouraging and further research is warranted to understand barriers and facilitators.

Health status, healthcare, and access in children with long-term medication use and difficulties with emotion, concentration, and behavior

PROBLEM

Children with chronic conditions often have difficulties with emotions, concentration, and behaviors (ECB) and are not recognized and treated adequately. In this paper, long-term medication use (LTM) was adopted as a proxy for chronic illness due to the lack of consistent and standardized diagnostic criteria for chronic illnesses in children.

METHODS

Children (8-12 years) were selected from the California Health Interview Survey (2017) based on: (1) households with children (<12 years), (2) parent/adult caregivers report about child's health indicating "yes" to, (3) "does your child require prescription medicine for a health condition that has lasted or is expected to last at least 12 months or more," and (4) "difficulties with ECB in past 6 months."

FINDINGS

A total of 1600 children were included by the CHIS data set, and children whose parental report had met the selection criteria were children with LTM (n = 144; 7.4 ± 2.9 years), ECB (n = 233; 8.16 ± 2.14), and both LTM + ECB (n = 62; 8.61 ± 1.81). Children with LTM+ ECB were Caucasian (56.4%), Hispanic (19.3%), and males (64.5%). Children with both LTM + ECB had two to three (33.87%) or at least four (53.2%) physician visits, and/or receiving special therapy (45.1%). Children with LTM had prescription delays (n = 144; 5.6%) and were not able to get medical care due to lack of insurance (n = 144; 6.9%). The majority of the children with LTM (54.2%) and LTM + ECB (43.5%) had parental employment-based insurance. More children that have both LTM and ECB (48.4%) than children with LTM, No ECB (32.9%) were on Medi-Cal/Medicaid.

CONCLUSION

Children with LTM need further evaluation for difficulties with ECB. Future studies are required to examine health status, healthcare use, and access for children with LTM and ECB.

Predictors of strain for Canadian caregivers seeking service navigation for their youth with mental health and/or addictions issues

Caring for youth with mental health and/or addictions (MHA) concerns is associated with caregiver strain, which may lead to negative consequences for youth and their caregivers. These consequences may be mitigated by caregivers and/or youth receiving assistance in navigating the healthcare system. Understanding what factors are associated with caregiver strain may be important in developing and implementing navigation services for such families; nonetheless, limited evidence currently exists regarding the predictors of strain in caregivers seeking navigation support. This study aimed to determine whether (a) the mental health profile of youth and (b) the home and family situation for youth with MHA concerns contribute significantly to strain in caregivers engaged in navigation. Data were collected from 66 adults caring for at least one youth with MHA issues accessing navigation service in Toronto, Ontario, between March and August 2018. Multiple linear regressions were conducted to determine which factors were associated with caregiver strain. The first regression model exploring youth-specific independent variables (adjusted r²  = .478, F_6,47  = 9.086, p < .001) demonstrated that lower levels of caregiver-rated youth health (β = -0.577, p = .001) and higher levels of youth mental health symptom severity (β = 0.077, p < .001) significantly predicted higher levels of strain. The second regression model (adjusted r²  = .348, F_5,54  = 7.287, p < .001) showed that lower levels of family functioning (β = -0.089, p < .001) significantly predicted higher levels of strain. Higher levels of caregiver strain in caregivers of youth with MHA concerns who are accessing navigation services are associated with lower levels of caregiver-rated youth health, higher levels of youth mental health symptom severity, and lower levels of family functioning. These predictors may be potential targets for providers aiming to reduce caregiver strain, as part of navigation or other healthcare services.

Correlates of help-seeking by parents for the socioemotional development of their 3-year-old children: a longitudinal study

OBJECTIVES

Timely parental help-seeking regarding their child's socioemotional development is associated with a lower rate and lower severity of psychosocial problems in later life. This study aimed to examine the correlates of parental help-seeking for the socio-emotional development of 3-year-old children.

DESIGN

Retrospective cohort study.

SETTING

Community-based survey in Rotterdam.

PARTICIPANTS

Of 2305 parents and their 2-year-old children at baseline, 1507 who completed follow-up questionnaires were included in the analyses when children were 3 years old.

OUTCOME MEASURES

Parental help-seeking regarding their child's socioemotional development and types of formal and informal help sources (eg, general practitioner, internet) used in the past 12 months were measured. Hierarchical logistic regression models were applied to identify factors correlates of parental help-seeking among 13 predisposing, enabling and need factors according to Andersen's behavioural model.

RESULTS

In total, 22.6% of parents reported help-seeking in the past 12 months for socioemotional development of their 3-year-old child; 6.8% addressed formal help sources and 17.5% addressed informal help sources. General practitioner (2.7%) and family (12.5%) were the most frequently used formal and informal sources, respectively. In the full model, predisposing factors associated with higher odds of parental help-seeking were child's other western ethnic background (OR=1.66, 95% CI 1.02 to 2.68) and parental age ≤29 years old (OR=1.71, 95% CI 1.01 to 2.92). No associated factors were found among enabling factors. The need factors associated with higher odds of parental help-seeking were having previous help-seeking (OR=2.52, 95% CI 1.83 to 3.48) and discussing child's socioemotional development in the well-child visit (OR=2.47, 95% CI 1.73 to 3.53).

CONCLUSIONS

Predisposing and need factors were associated with parental help-seeking for socioemotional development of 3-year-old children. The findings can be used to further develop support for parents accessing adequate information, prevention and anticipatory care with regards to the child's socio-emotional development.

Changes in referral patterns to outpatient child and adolescent psychiatric services from 2005-2018

INTRODUCTION

There has been a steep increase in referrals to child and adolescent psychiatric (CAP) services across Western countries. To fit CAP services to the increasing demand, it is important to gain more knowledge about the background for the increase in referrals and to investigate changes in referral patterns over time.

METHODS

Cross-sectional observational study comparing referrals to outpatient CAP services from 2005, 2010 and 2018 to the only CAP center in the North Denmark Region.

RESULTS

There was a 3.9 times increase in referrals from 2005 to 2018. Referrals for disorders with onset in early childhood (primarily autism and ADHD/ADD) increased from 2005 to 2010 but decreased from 2010 to 2018. There was an increase in the proportion of referrals for emotional disorders from 2010 to 2018. The proportion of girls referred for disorders with onset in early childhood increased from 2005 to 2018. The referral age for these disorders remained relatively high, and this was most pronounced for girls.

CONCLUSIONS

There has been significant changes in the referral pattern to outpatient CAP services. The increasing referral rates for girls for disorders with onset in early childhood could indicate improved ability in primary settings to recognize these symptoms in girls. However, late referral to CAP services for these disorders remains an issue. Educational services play an increasing role in referring children for these disorders, and it is important to ensure that they have the competences to identify children in need of assessment by CAP services.

Parent-perceived barriers to accessing services for their child's mental health problems

BACKGROUND

Many children and adolescents with impairing mental health disorders are not in contact with specialized child and adolescent mental health services (CAMHS). In order to close the service gap, it is important to increase our knowledge of barriers to access. The aim of this study was to investigate parent perceived barriers to accessing services for their child's mental health problems to identify potential areas for improvement of access to CAMHS.

METHOD

In this cross-sectional observational study 244 parents of children and adolescents referred to outpatient psychiatric assessment were interviewed using the Children's services interview regarding barriers to accessing child mental health services across healthcare, educational services and social services. Parent reported barriers were analyzed in relation to the child's age, referral reason, symptom duration and impairment of the child.

RESULTS

The most commonly reported barriers were lack of information about were to seek help (60.3%), the perception that professionals did not listen (59.8%) and professionals refusing to initiate interventions or provide referral to services (53.7%). Lack of knowledge, stigmatization and unavailability of services were common themes across barriers to help-seeking. Long symptom duration and parent rated impairment was associated with increased risk of reporting several barriers to help-seeking.

CONCLUSION

Parents seeking help for their child's mental health encounter numerous barriers that could explain part of the treatment gap and long duration of mental health problems in children prior to referral to CAMHS.

The needs and service preferences of caregivers of youth with mental health and/or addictions concerns

BACKGROUND

Caregivers experience significant strains as a result of navigating the complex mental health and/or addiction (MHA) system for their youth with MHA issues. We examined the characteristics of Ontario families with youth with MHA issues and their service needs.

METHODS

A cross-sectional survey study investigated the characteristics and service needs of families with youth with MHA issues across the province of Ontario, Canada. A total of 840 caregivers were recruited.

RESULTS

259 participants (Mage = 45.94, SD = 7.11) identified as caregiving for at least one youth with MHA issues. The majority of the participants were female (70.7%), married (73.4%), and completed at least some college/Bachelor degree (59.1%). The mean age of youth was 16.72 years (SD = 5.33) and the most frequently reported diagnoses were Depression (30.1%), ADHD (27.8%) and Generalized Anxiety Disorder (21.2%). Regression results demonstrated that presently accessing services, presently seeking services, and higher levels of barriers MHA services were significantly predictive of identifying navigation as helpful for finding appropriate MHA services (χ2(7) = 28.69, p < .001, Nagelkerke R2 = .16). Furthermore, presently accessing services was significantly predictive of identifying case management as helpful (χ2(7) = 29.59, p < .001, Nagelkerke R2 = .156), and of identifying a primary healthcare provider as helpful (χ2(7) = 38.75, p < .001, Nagelkerke R2 = .197) for finding appropriate MHA services.

CONCLUSION

Identifying the nature and extent of youth MHA issues, service needs, and family preferences can inform the development of services that address families' needs and lend vital support for accessing services within a complex system.

Parents' constructions of normality and pathology in child mental health assessments

Central to a contemporary understanding of childhood is the developmental and clinical-medical construct of the 'normal' child. When judged to fall outside of culturally, socially and historically situated parameters of 'normality', children become labelled as 'deviant from the norm'; for instance, in mental health contexts where this may provide the basis for psychiatric diagnosis. However, judgements of a child's 'normality' are further complicated by the range of individuals who may have a stake in that construction, including parents/carers, professionals and the child themselves. Using discursive psychology, we analysed 28 video-recorded UK child mental health assessments, to examine ways that parents presented concerns about their children's development. They did this by drawing on notions of 'ab/normal', in ways that functioned to legitimise their need for services and built a rhetorical case to demonstrate clinical need; often by contrasting the child with other 'typical' children and/or contrasting the same child's behaviour in different settings or contexts. We concluded that given the growing crisis in child mental health, initial assessments play a crucial clinical role in determining diagnosis and labelling, and therefore, a critical discussion of these concepts and processes is essential.

"Just keep pushing": Parents' experiences of accessing child and adolescent mental health services for child anxiety problems

BACKGROUND

Anxiety disorders are among the most common psychopathologies in childhood; however, a high proportion of children with anxiety disorders do not access effective treatments. The aim of the present qualitative study was to understand families' experiences of seeking help and accessing specialist treatment for difficulties with childhood anxiety.

METHODS

Parents of 16 children (aged 7-12 years) referred to a child mental health service for difficulties with anxiety were interviewed about their experiences of seeking and accessing treatment within Child and Adolescent Mental Health Service (CAMHS). All interviews were transcribed verbatim and thematically analysed for similarities and differences in families' experiences.

RESULTS

Factors that helped and/or hindered families accessing treatment related to (a) parental recognition, (b) contact with professionals, (c) reaching CAMHS, (d) parental effort, and (e) parental knowledge and concerns. High demands on services and parents' uncertainty surrounding the help-seeking process presented key hurdles for families. The critical role of parental persistence and support from general practitioners and school staff was evident across interviews.

CONCLUSIONS

Findings highlighted the need for information and guidance on identifying child anxiety difficulties and professional, peer, and self-help support, and ensuring sufficient provision is available to allow families prompt access to support.

Increasing Access to Psychiatric Services in Schools: The Bridge Program

One in 5 youth experience a psychiatric disorder in any given year, but fewer than half of these youth receive mental health services. This lack of service utilization is often attributed to structural and perceptual barriers, and school-based mental health programs have been proposed as a means of addressing these barriers and increasing youths' access to services. While universal prevention programs and targeted treatments may benefit most youth receiving services in schools, collaborations between schools and child psychiatry may benefit youth with the most severe symptoms and the greatest impairment. This article describes the Bridge Program, a school-based psychiatric program funded by a county-wide mental health tax initiative designed to provide psychiatric services in local schools without any out-of-pocket expenses for youth and families within 10 days of referral. Two case reports provide a description of the delivery of psychiatric services through the Bridge Program. Future research is needed to compare the feasibility and effectiveness of different approaches to increasing access to youth psychiatric care.

Enrolment of children in psychosocial care: problems upon entry, care received, and outcomes achieved

Psychosocial care systems have been designed so that specific problems are treated by specific care types. There is insufficient evidence as to which problem types are actually presented to the various care types. This study assessed types and severity of problems among children and adolescents upon enrolment in psychosocial care, compared to children not enrolled; also outcomes after 3 and 12 months, overall and per care type. We obtained data on a cohort of 1382 Dutch children aged 4-18 years (response rate 56.6%), included upon enrolment in psychosocial care, and on 443 not-enrolled children (response rate 70.3%), all from one region. Results showed that enrolled children had more problems than children not enrolled in care. In child and adolescent mental healthcare (CAMH), relatively many children had internalizing problems, and in child and adolescent social care (CASC) relatively many children had externalizing, parenting, family and multiple problems. Regardless of the type of problem, care duration in preventive child healthcare (PCH) was relatively short; and in CASC and CAMH longer. After 3 and 12 months, rates of problem solution were highest in PCH. These rates were also substantial among children not in care. To conclude, our findings show that the system of psychosocial care functions as intended regarding the distribution of problems across care types. Extended demarcation of clients by problem type and severity towards type and contents of care may further improve the system.

Evaluating the parent-adolescent communication toolkit: Usability and preliminary content effectiveness of an online intervention

Aim

This study aimed to assess the Parent-Adolescent Communication Toolkit, an online intervention designed to help improve parent communication with their adolescents. Participant preferences for two module delivery systems (sequential and unrestricted module access) were identified.

Design

Usability assessment of the PACT intervention was completed using pre-test and posttest comparisons. Usability data, including participant completion and satisfaction ratings were examined.

Methods

Parents (N = 18) of adolescents were randomized to a sequential or unrestricted chapter access group. Parent participants completed pre-test measures, the PACT intervention and posttest measures. Participants provided feedback for the intervention to improve modules and provided usability ratings. Adolescent pre- and posttest ratings were evaluated.

Results

Usability ratings were high and parent feedback was positive. The sequential module access groups rated the intervention content higher and completed more content than the unrestricted chapter access group, indicating support for the sequential access design. Parent mean posttest communication scores were significantly higher (p < .05) than pre-test scores. No significant differences were detected for adolescent participants. Findings suggest that the Parent-Adolescent Communication Toolkit has potential to improve parent-adolescent communication but further effectiveness assessment is required.

Black and White Parents' Willingness to Seek Help for Children's Internalizing and Externalizing Symptoms

OBJECTIVE

Understanding social and environmental factors that contribute to parental help-seeking intentions is an important step in addressing service underutilization for children in need of treatment. This study examined factors that contribute to parents' intentions to seek formal and informal help for child psychopathology (anxiety and attention-deficit/hyperactivity disorder [ADHD]).

METHOD

A total of 251 parents (N = 128 mothers, N = 123 fathers; 49% Black, 51% White) read 3 vignettes describing children with anxiety, ADHD, and no diagnosis. Measures of problem recognition, perceived barriers, and formal (pediatricians, psychologists, teachers) and informal (religious leaders, family/friends, self-help) help seeking were completed. Four separate hierarchical logistic regression models were used to examine parental help-seeking likelihood from formal and informal sources for internalizing and externalizing symptoms. Predictors were socioeconomic status, parent race, age, and sex, parent problem recognition (via study vignettes), and perceived barriers to mental health service utilization.

RESULT

Mothers were more likely than fathers to seek help from pediatricians, psychologists, teachers, and religious leaders for child anxiety and pediatricians, religious leaders, and self-help resources for child ADHD. Black parents were more likely to seek help from religious leaders and White parents were more likely to use self-help resources. Problem recognition was associated with greater intentions to seek help from almost all formal and informal sources (except from friends/family).

CONCLUSION

Understanding factors that contribute to parental help seeking for child psychopathology is critical for increasing service utilization and reducing the negative effects of mental health problems. This study highlights the importance of decreasing help-seeking barriers and increasing problem recognition to improve health equity.

Parent-reported stigma and child anxiety: A mixed methods research study

BACKGROUND

Stigma has been frequently cited as a barrier to service use for various mental health problems. Studies suggest that stigma may be greater for childhood mental health problems that are perceived as more atypical.

AIMS

This study utilized a mixed methods research design (qual + QUAN) to examine parental endorsement of stigma and its impact on service utilization among children with significant anxiety-a common childhood problem frequently perceived as normative.

METHODS

Semi-structured qualitative interviews were conducted with 29 parents of anxious children. Qualitative data were coded using a grounded theory approach, and stigma-related responses were examined for emergent themes. Quantitative data was analyzed with frequency counts and chi-square analysis.

RESULTS

Stigma related to children's anxiety symptoms and seeking mental health services was reported by 41.3% (n = 12) of parents. Emergent themes included: 1) Parental Concern for Negative Consequences, 2) Parent Internalized Stigma, and 3) Negative Associations with Mental Health Treatment. Latino parents discussed stigma more frequently than non-Latino White parents (70% vs. 17.6%, respectively, X²(1, N = 27) = 5.33, p < 0.05).

CONCLUSIONS

Although anxiety is a common childhood problem, stigma is still frequently reported by parents and may be an important barrier to mental health service use, especially among Latino youth.

Youth Descriptions of Mental Health Needs and Experiences with School-based Services: Identifying Ways to Meet the Needs of Underserved Adolescents

While schools serve as a common entry point into mental health services for underserved youth, engagement of students in need of care remains a problem. Little is known about the ways schools can best address students' mental health needs, especially from the perspective of youth who struggle to attend school, a vulnerable group with a high burden of mental health problems. A qualitative descriptive approach was used to analyze data from in-depth interviews with a sample of 18 youth with a history of school truancy and mental health problems. Analyses explored how youth expressed mental health symptoms, and their trajectories through, and perceptions of, school-based mental health services. Results suggest that participants experienced multiple, overlapping symptoms; only a portion had their needs addressed. The quality of relationships with school staff and the perceived efficacy of treatment affected service trajectories. Promising school-based approaches to address students' mental health needs are discussed.

Defining Episodes of Care in Children's Mental Health Using Administrative Data

Criteria to define an episode of care in children's mental health services are needed. Various criteria were applied to 5 years of visit data from children 4-11 years (N = 5,206) at their first visit to 1 of 3 children's mental health agencies. A minimum of 3 visits with 180 days between episodes optimized agreement with other dates (e.g., telephone intake assessment) marking the start and end of an episode, and clinician-rated number of episodes. Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.

An investigation into GPs' perceptions of children's mental health problems

BACKGROUND

Mental health disorders in children are common. General practitioners (GPs) have a significant role in the detection of these disorders, yet there is lack of evidence to assess this ability. This study aimed to explore GPs' recognition of children's mental health problems, examining GPs' ability to identify both a common emotional and behavioural disorder.

METHOD

Between November 2014 and March 2015, an online survey-based questionnaire measure was used, composed of a series of six clinical vignettes designed to assess GPs' mental health literacy with respect to children of primary school age. This included recognition accuracy, rating of problem severity, and degree of concern about hypothetical cases, described in the vignettes.

RESULTS

Of the 97 participants, all identified the clinical level separation anxiety disorder and 97.9% identified the clinical level oppositional defiant disorder. Nonparametric analyses identified a significant difference (Z = -5.44, p < .0001, r = .55) in the GPs' concern for the child with clinical oppositional defiant disorder versus the concern for the child with clinical separation anxiety disorder. Participants were significantly more concerned about a boy presenting with clinical separation anxiety (Z = -7.18, p < .001, r = .72) than a girl. Also, participants were significantly more concerned about a boy presenting with clinical level oppositional defiance (Z = -7.79, p < .001, r = .79).

CONCLUSION

This study shows the majority of GPs can identify a primary school child with clinical level symptoms of either a common emotional or behavioural disorder described in a written vignette. However, GPs were more concerned when the child was male or displaying symptoms of a behavioural disorder.

Pathway model of parental help seeking for adolescents experiencing first-episode psychosis

AIM

Parents and caregivers are confronted with many challenges when caring for adolescents experiencing first-episode psychosis (FEP). Understanding and support for parental help-seeking process is essential for adolescents' timely access to treatment. The study aimed to develop a pathway model of parental help seeking for adolescents experiencing FEP and identify crucial time points for intervention.

METHODS

Directed content analysis was conducted on semi-structured qualitative interviews of 16 parents whose children had experienced FEP and focused on parents' experiences prior to and during FEP until first hospitalization.

RESULTS

The resultant parental help seeking for FEP model included two stages and six phases. The contemplation stage is composed of phases of initial awareness, recognizing severity and considering options. The action stage entailed help-seeking intention, securing help and service appraisal. All parents promptly began help seeking after recognizing severe symptoms and sought advice from professional and community supports, although parents' lack of initial awareness was common. Further analysis on individual parents' help-seeking trajectories showed that among the 50% parents who reported pre-existing childhood conditions, 87.5% did not report initial awareness of psychotic symptoms.

CONCLUSIONS

Findings recommend intervention at three specific periods of help seeking. First, psychoeducation is needed when parents first engage with health care for their children's disabling conditions. Professionals treating childhood conditions need training to vigilantly monitor the overall mental health of the children over time. Second, it is important to enhance the roles of formal and informal community resources in facilitating parental help seeking. Finally, family-focused interventions are essential in supporting the family for securing needed treatment.

Why wait? The effect of wait-times on subsequent help-seeking among families looking for children's mental health services

Placement on a wait-list may increase families' help-seeking efforts, leading them to contact more than one children's mental health (MH) agency/professional. Two issues were examined in the current study: 1) Does time on a wait-list for families impact the time to contact a new agency for children's MH services? 2) What are the effects of predisposing (e.g., child age), need (e.g., child psychopathology), and enabling/system-level factors (e.g., parent treatment history) on the length of time parents wait before they contact a new agency for help with their child's MH problems? A total of 273 families seeking help for their child (64% boys, M = 10.7 years old, SD = 3.3) were asked about their contact with MH agencies/professionals during the previous year. Survival analyses, modeling time from initial wait-list placement to when a new agency was contacted, were conducted separately for families who did (n = 114), and those who did not (n = 159), receive help prior to contacting a new agency. Almost half of wait-listed families contacted a new agency by the end of the study period. Longer wait-time was associated with a greater likelihood of seeking help at a second agency with 25% of families contacting a new agency within the first month of being wait-listed. Parents with previous treatment experience and families living in areas with more agencies contacted a new agency sooner. Subsequent help-seeking behaviour suggests parents' intolerance for lengthy treatment delays may result in disorganized pathways to care. These findings suggest a highly fragmented service delivery system.

Child problem recognition and help-seeking intentions among black and white parents

Parents play a central role in utilization of mental health services by their children. This study explored the relationship between parents' recognition of child mental health problems and their decisions to seek help. Participants included 251 parents (49% Black, 51% White; 49% fathers, 51% mothers) recruited from community settings. Parents ranged in age from 20 to 66 years old with at least one child between ages 2 and 21. Parents read three vignettes that described a child with an anxiety disorder, ADHD, and no clinically significant diagnosis. Parents completed measures of problem recognition, perception of need, willingness to seek help, and beliefs about causes of mental illness. Findings from Generalized Estimating Equations revealed that parents were more likely to report intentions to seek help when they recognized a problem (odds ratio [OR] = 41.35, p < .001), 95% confidence interval (CI) [14.81, 115.49]; when it was an externalizing problem (OR = 1.85, p < .05), 95% CI [1.14, 3.02]; and when parents were older (OR = 1.04, p < .05), 95% CI [1.01, 1.08]. Predictors of parental problem recognition included perceived need, prior experience with mental illness, and belief in trauma as a cause of mental illness. Predictors of help-seeking intentions included problem recognition, perceived need, externalizing problem type, and being female. Given the relationship between parental problem recognition and willingness to seek help, findings suggest that efforts to address disparities in mental health utilization could focus on problem-specific, gender-sensitive, mutable factors such as helping parents value help-seeking for internalizing as well as externalizing problems.

The role of maternal perceptions and ethnic background in the mental health help-seeking pathway of adolescent girls

Mothers play a crucial role in the help-seeking pathway of adolescents. This study examined how mothers with different ethnic backgrounds perceive the issue of help-seeking for internalizing problems (e.g. depression) in adolescent girls. Seven focus group discussions were conducted with 41 Dutch, Moroccan and Turkish mothers with a teenage daughter. Discussions were conceptually framed within a model of help-seeking and facilitated by a vignette. The internalizing problems sketched in the vignette were recognized as severe nonetheless; identified long term consequences varied per ethnic group. Negative attitudes towards General Practitioners, inaccessible mental health services and denial by daughters would hamper help-seeking. Fear of negative judgments/gossiping was considered a barrier by Turkish and Moroccan participants. Participants identified themselves and schools as primary sources of help. Turkish participants also named chaplains. To enhance utilization of mental health services by (minority) youth it is important to also address maternal barriers.

Youth at ultra high risk for psychosis: using the Revised Network Episode Model to examine pathways to mental health care

AIM

This paper aims to identify the ways in which youth at ultra high risk for psychosis access mental health services and the factors that advance or delay help seeking, using the Revised Network Episode Model (REV NEM) of mental health care.

METHODS

A case study approach documents help-seeking pathways, encompassing two qualitative interviews with 10 young people and 29 significant others. Theoretical propositions derived from the REV NEM are explored, consisting of the content, structure and function of the: (i) family; (ii) community and school; and (iii) treatment system.

RESULTS

Although the aspects of the REV NEM are supported and shape pathways to care, we consider rethinking the model for help seeking with youth at ultra high risk for psychosis.

CONCLUSIONS

The pathway concept is important to our understanding of how services and supports are received and experienced over time. Understanding this process and the strategies that support positive early intervention on the part of youth and significant others is critical.

Children First

Although the importance of healthy mental development in children and youth is not disputed, the mental health needs of far too many Canadian children are being ignored. Within the context of recent federal and provincial calls for systemic reform of the mental health care systems for children and youth, we underscore the necessity for ongoing innovation, development, education, and evaluation. This article describes our aims to establish demonstration and research sites focused on promising frameworks that draw from systems of care, public health, and resiliency approaches.

Les pratiques collaboratives : nouveau fétichisme ou « praxis » renouvelée dans le champ de la santé mentale des enfants ? De la nécessité d’une halte dans l’instant des sens

Cet article tente de faire une relecture des pratiques collaboratives en tant que nouveaux modes d’appréhension de « l’être ensemble et le faire ensemble » dans le champ de la santé mentale de l’enfant. Il a une visée théorique et non empirique. Nous souhaitons surtout amorcer une réflexion sur les pratiques collaboratives en partant du service social en tant que discipline reposant sur le don et le contre-don, donc disposant de leviers pour relier les professions au chevet de l’enfant. Il s’agit aussi de proposer une pause pour s’extirper des lieux communs et réinterroger les concepts reliés aux pratiques collaboratives centrées sur l’enfant. L’article est subdivisé en quatre parties qui poursuivent chacune des objectifs différents. Dans un premier temps nous abordons la santé mentale de l’enfant en tant que champ à définir dans un espace théorique et de pratique d’essence collaborative. La deuxième partie a été l’occasion pour nous de tenter une nouvelle exploration sémantique des concepts de collaboration et de partenariat. La troisième partie présente le service social dans sa fonction de passeur de sens dans l’enjeu d’un travail collaboratif centré sur l’enfant. La quatrième partie illustre le travail collaboratif en posant les cadres de pratique processuels dans le champ de la santé mentale de l’enfant.

The interim service preferences of parents waiting for children's mental health treatment: a discrete choice conjoint experiment

Parents seeking help for children with mental health problems are often assigned to a waiting list. We used a discrete choice conjoint experiment to model preferences for interim services that might be used while waiting for the formal assessment and treatment process to begin. A sample of 1,059 parents (92 % mothers) seeking mental health services for 4 to 16 year olds chose between hypothetical interim services composed by experimentally varying combinations of the levels of 13 interim service attributes. Latent Class analysis yielded a four-segment solution. All segments preferred interim options helping them understand how agencies work, enhancing their parenting knowledge and skill, and providing an opportunity to understand or begin dealing with their own difficulties. The Group Contact segment (35.1 %) preferred interim services in meetings with other parents, supported by phone contacts, frequent checkup calls, and wait-time updates. Virtual Contact parents (29.2 %) preferred to meet other parents in small internet chat groups supported by e-mail contact. Membership in this segment was linked to higher education and computer skills. Frequent Contact parents (24.4 %) preferred face-to-face interim services supported by weekly progress checks and wait time updates. Limited Contact parents (11.3 %) were less intent on using interim services. They preferred to pursue interim services alone, with contacts by phone, supported by fewer check-up calls and less frequent wait time updates. All segments were more likely to enroll in interim services involving their child.

Randomized trial of distance-based treatment for young children with discipline problems seen in primary health care

OBJECTIVE

Many parents of preschool-age children have concerns about how to discipline their child but few receive help. We examined the effects of a brief treatment along with usual care, compared with receiving usual care alone. Patients. Parents (N = 178) with concerns about their 2- to 5-year olds' discipline were recruited when they visited their family physician at 1 of 24 practices.

METHODS

After completing mailed baseline measures, parents were randomly assigned to receive usual care or the Parenting Matters intervention along with usual care. Parenting Matters combined a self-help booklet with two calls from a telephone coach during a 6-week treatment period. Follow-up assessments were completed at 7 weeks post-randomization, and 3 and 6 months later.

RESULTS

Behaviour problems (Eyberg Child Behaviour Inventory) decreased significantly more in the Parenting Matters condition compared with Usual Care alone, based on a significant time by treatment group effect in intent-to-treat, growth curve analyses (P = 0.033). The Parenting Matters group also demonstrated greater and more rapid improvement than in usual care alone in terms of overall psychopathology (Child Behaviour Checklist, P = 0.02), but there were no group differences in parenting. The overall magnitude of group differences was small (d = 0.15 or less).

CONCLUSION

A brief early intervention combining a self-help booklet and telephone coaching is an effective way to treat mild behaviour problems among young children. This minimal-contact approach addresses the need for interventions in primary health care settings and may be a useful component in step-care models of mental health.

Nonmedical healing methods: knowledge and behavior among parents of children with mental health problems

This study examined knowledge and behavior concerning nonmedical healing methods used by parents whose children present with mental health problems and to determine the factors affecting this behavior. Knowledge of a variety of nonmedical health methods was found to be more common than use of such methods. Among those expressing knowledge of such methods, religious procedures were found to be more common than those that are nutrition related. Also, nonmedical healing method use increased as the mother's age decreased. We found a significant relationship between nonmedical healing method--using behavior and a positive family history of nonmedical healing method usage. Education about mental health problems and their treatment is very important, especially for young mothers. Increased understanding about nonmedical healing methods among health care providers will improve the patient-family-provider relationship.

Negotiating the pathways into care in a globalizing world: help-seeking behaviour of ultra-Orthodox Jewish parents

BACKGROUND

The study of the pathways into care as a social process subject to a wide range of influences is needed to build appropriate and effective mental health services for culturally diverse societies.

MATERIAL

Grounded theory and situational analysis of 21 in-depth interviews explores the help-seeking behaviour of ultra-Orthodox Jewish parents: which help-seeking pathways parents follow and how they make the decision to consult regular services for their child.

DISCUSSION

Three help-seeking pathways are influenced by globalization dynamics and gender: parents draw on diverse parenting discourses and strategies, socio-religious frameworks and cultural realities.

CONCLUSION

Strategies are suggested to enhance the accessibility of services.

Teachers' Recognition of Children's Mental Health Problems

BACKGROUND

  Teachers have a significant role to play in identifying children with mental health problems. However, teachers' perceptions of children's mental health problems are relatively unexplored.

METHOD

  Primary school teachers (N = 113) completed a questionnaire, composed of vignettes describing children with symptoms of a common emotional disorder and a common behavioural disorder, following which they were asked a number of questions regarding problem recognition and help-seeking.

RESULTS

  Teachers were able to recognise the existence of a problem and rate its severity. They were significantly more concerned about a vignette of a child with symptoms of a behavioural disorder than an emotional disorder. The gender of the child was found to independently predict teachers' accurately recognising when a child had a problem.

CONCLUSION

  Teachers are good at recognising whether a child presents with a problem. However, their problem recognition is affected by both the gender of the child and the type of symptomatology being displayed (emotional versus behavioural).

Examining the meaning attached to mental illness and mental health services among justice system-involved youth and their parents

A large percentage of youth involved in the juvenile justice system experience mental health problems, yet many do not receive mental health care. In this study, we used a process-focused framework of mental health decision making to gain insight into the use of mental health services among these youth. In-depth interviews were conducted with nine youth and nine parents participating in a program servicing youth with mental health problems who have been in detention. Themes related to problem recognition, the decision to seek and participate in services, subjective norms, and juvenile justice system involvement emerged. Most families acknowledged their youth was having problems, but few defined those problems in mental health terms. This did not prevent them from seeking services, although some were not able to access adequate services until the justice system became involved. Participants were aware of negative attitudes about mental illness, and might have limited their social networks to shield themselves.

Establishing best practice in pediatric emergency mental health: a prospective study examining clinical characteristics

OBJECTIVES

The objectives of this prospective study were to determine the demographic and clinical characteristics of children and youth presenting to the emergency department (ED) for mental health concerns through the use of a valid standardized assessment protocol.

METHODS

Children and adolescents, 8 to 17 years, who presented to an ED-based crisis intervention program during fiscal years 2005 to 2006, completed self-report measures of depression, anxiety, and behavior. Clinicians completed the childhood acuity of psychiatric illness based on their assessment.

RESULTS

The clinician ratings indicated that 93.1% of the sample had at least 1 risk behavior or clinical symptom in the moderate/severe range. Admittance rate for the sample was 17.9% (low-risk admissions, 5.8%; high-risk deflections, 9%). Significant differences were found in presentations by sex and age as follows: (1) female youths (12-17 years) were more likely than male youth to report clinically significant depressive symptoms and to present with suicidal ideation/gesture and self-injury. (2) Male youths (12-17 years) were more likely to present with aggression to people/objects than female youth. (3) Male children younger than 12 years were more likely to present with high activity level than female children. Self-report measures (depression, anxiety, and behavior) corelated with corresponding clinician ratings.

CONCLUSIONS

This research, through the use of a multi-informant standardized assessment protocol, presents a comprehensive study of children and youth presenting to the ED with mental health issues. Identifying the clinical characteristics of this population is an important first step toward establishing best practice within an ED.