The relationship between children\u27s perception of barriers to mental health care and service utilization across five service systems

There is an abundance of unmet mental health needs among children in the United States. Perceived barriers to mental health care have been long theorized to have a direct impact on the mental health service utilization of children. However, much of what is known about the perceived barriers of children has come from parent and caregiver reports. Using secondary data analysis, this hypothesis-driven dissertation study sought to understand the relationship between children\u27s perception of barriers to mental health care and service utilization. There were two unique aspects of this dissertation study. First, the data (N=763) was obtained directly from children and second, it involved children across five service systems: mental health, special education, child welfare, juvenile justice, and substance use. The data used for this study was derived from the Alternative Service Patterns for Children with Serious Emotional Disturbance, an NIMH-funded health services and epidemiological study (1993--1998, RO1 MH469091). This dissertation study employed cognitive, ecological and organizational theoretical frameworks to guide the understanding of how individual, psychological, service-based, and parental factors influence the perception of barriers and how these perceived barriers impact mental health service use. Results indicated that children indeed had barriers they perceived toward mental health care. The statistically significant barriers that children perceived were: concerns about what others might think, not being sure where to go for help, and other (unspecified) reasons. Results from the logistic regression models indicated that what was most predictive of mental health service utilization was the race of the child (being white), a parent that did not have a child that believed s/he could solve the problem on her/his own, and a child that was not involved in the child welfare, special education, or juvenile justice service systems. The findings of the dissertation study can facilitate attempts to predict service utilization, determine why some children access mental health services while others do not or prematurely drop out from mental health treatment, and facilitate efforts to provide appropriate and timely mental health services. Based on these research findings, implications for social work practice, education, and research are also discussed