Article

Pathways to Service Receipt: Modeling Parent Help-Seeking for Childhood Mental Health Problems

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Abstract

Understanding parent appraisals of child behavior problems and parental help-seeking can reduce unmet mental health needs. Research has examined individual contributors to help-seeking and service receipt, but use of structural equation modeling (SEM) is rare. SEM was used to examine parents' appraisal of child behavior, thoughts about seeking help, and receipt of professional services in a diverse, urban sample (N = 189) recruited from women infant and children offices. Parents of children 11-60 months completed questionnaires about child behavior and development, parent well-being, help-seeking experiences, and service receipt. Child internalizing, externalizing, and dysregulation problems, language delay, and parent worry about child behavior loaded onto parent appraisal of child behavior. Parent stress and depression were positively associated with parent appraisal (and help-seeking). Parent appraisal and help-seeking were similar across child sex and age. In a final model, parent appraisals were significantly associated with parent thoughts about seeking help, which was significantly associated with service receipt.

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... If parents do seek professional help, they are also unlikely to sufficiently adhere to and engage with treatment for full implementation of evidence-supported treatments [5]. Therefore, reviews of mental health service utilisation have, emphasised that, to reduce the discrepancy between need and service use, it is important to investigate factors influencing parents' motivation and willingness to seek and engage with professional help [7]. ...
... Help-seeking models relevant for child mental health suggest that child symptoms alone are not enough to motivate service utilisation. These models hypothesise that parents' motivation to seek help for child problems result from recognising and appraising child problems as problematic, including the causes (attributions), meaning (worry about child behaviour), and perceptions of child problems (e.g., perceived severity, susceptibility), which subsequently lead to decisions to seek help [7][8][9][10]. Further, these models hypothesise that parents' progress from decisions to seek help to actual service utilisation by evaluating structural barriers and facilitators, including availability of professional help, economic factors, and service characteristics such as waiting times and referral care pathways [e.g., primary care to specialist services; 8,10]. ...
... The current results are consistent with help-seeking models proposing that parental attributions for child problems contribute to explaining individual differences in parents' willingness to seek and engage professional help [7][8][9]13]. Findings were consistent even when problem type and severity were considered. ...
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There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers’ attributions about their child’s problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers’ anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β = – .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β = – .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.
... Research has identified numerous factors that influence the accessibility of CAMH services including socioeconomic status (SES), race, geographical location and insurance status [7][8][9][10][11][12][13][14][15][16][17][18]. SES and race have been identified as two of the most significant determinants of CAMH service utilization. ...
... SES and race have been identified as two of the most significant determinants of CAMH service utilization. However, there have been a limited number of empirical studies in the United States of America examining the impact on parental help-seeking practices in CAMH from the perspective of: time between problem recognition and help seeking (Lag Time), the person(s) to whom parents first voice their concerns (Parental Confidants) and the individual(s) who recommended seeking a child psychiatric consultation (Referral Sources) [14][15][16][17][18][19][20][21]. Our study sought to examine these aspects of the parental path to CAMH through the lens of SES and Race. ...
... Our study adds to the body of literature in the United States of America assessing the impact of SES and Race on the pathways to CAMH. It furthers the literature by providing data on the time and actions parents take between recognition of symptoms of MI in their child or adolescent and help seeking (lag time) [13][14][15][16][17][18][19][20][21]. ...
Article
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To examine how socioeconomic status (SES) and race affect parents' initial response (IR) to their child’s mental illness (MI) including 1. Parental confidant(s); 2. Lag time in professional help-seeking; and 3. Referral source. 70 parents of patients new to a Child Psychiatry clinic completed a survey to assess their IR to their child’s MI. SES was determined using the United States Census Bureau median income by zip codes. Summary statistics are frequencies and percentages for categorical data, and medians and quartiles for continuous data. Twenty-five percent of parents reported low SES and 31% Non-Caucasian Children (NCC). Confidants of Caucasian and NCC were Pediatrician (77% vs 50%, p = 0.03), and family (73% vs 32%, p = 0.002). Comparing help-seeking Lag Times 66% reported a delay of 1 year or more (p = 0.040). Overall Pediatricians were the leading confidant. Lag times were one year or more with stronger trends in NCC.
... This help-seeking thus depends on adult appraisals of the child's symptoms (etiology, severity, and stability) and on physical, financial, and perceptual barriers that might inhibit service engagement. A variety of theory-and datadriven models have been proposed and tested to identify factors that influence adult helpseeking for child mental health concerns (Arcia and Fernández 2003;Godoy et al. 2014;Bayer 2015, 2017;Pavuluri et al. 1996; Thompson and May 2006;Zwaanswijk et al. 2005). While these models provide important information about the individual factors that affect a parent's help-seeking intentions and/or behavior, less is known on how best to integrate and apply these findings. ...
... Parents of children with disruptive behavior may also become habituated to a higher level of symptoms, developing a higher "threshold" for concerns along with lower expectations for compliance (Arcia and Fernández 2003;Baden and Howe 1992). This may influence help-seeking intention and behaviors, in that caregiver strain and 1 3 family impact often drive help-seeking behavior for child mental health problems (Angold et al. 1998;Bussing et al. 2003a;Godoy et al. 2014). Further, caregiver strain may vary by DBD symptom type. ...
... Construct validity of the HSSOC was assessed by testing the concurrent relationship at baseline between the HSSOC total readiness score and four factors associated with helpseeking for child mental health concerns: number of DBD symptoms (Angold et al. 1998;Teagle 2002), parental problem perception (Arcia and Fernández 2003;Oh and Bayer 2015), perceived parental burden (Angold et al. 1998;Bussing et al. 2003a;Godoy et al. 2014), and reported family resources (Bussing et al. 2003b;Owens et al. 2002), controlling for the effects of demographic factors and cohort. Based on the observed mean distribution of the total readiness score, linear regression with robust standard errors was used to predict readiness score from the help-seeking factors. ...
Article
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Background: Most families of children with behavior problems do access treatment. Objective: The purpose of this study was to test a parental measure of readiness to seek help for their child’s behavior problems. Method: Data was collected annually from 148 parents at their child’s first contact with either mental health services or juvenile justice court or services. Psychopathology, service use, and factors related to service use were assessed. The majority of the sample was male (64%) and Black/African American (63%) with a mean age of 11.93 years (SD=2.75). We administered a measure specifically developed for this study to assess stages of change in parents’ readiness to seek help for their child’s behavior problems. We used confirmatory factor analysis (CFA) to evaluate the stages of change and regression modeling to assess construct and criterion validity of the resulting readiness score. Results: CFA of the revised subscales showed acceptable ft. Readiness scores were associated with current and future use of specialty mental health services. Higher readiness scores were associated with parents perceiving their child’s behavior as worse compared to peers, more child attention-deficit/hyperactivity disorder symptoms, and greater parental burden. Higher readiness scores were not associated with total family resources, symptoms of oppositional defiant disorder or conduct disorder. Conclusion: Scores from this measure were associated with factors that predict service engagement, and predict current and future mental health service utilization. These results indicate construct and criterion validity of measuring parental help-seeking for child behavior problems within a stages of change framework.
... The parent-mediated pathway to adolescent help-seeking can be summarized in three steps: (1) problem recognition-the realization that observed symptoms/behaviors are problematic; (2) decision to seek help-recognizing the benefits of treatment; and (3), treatment selection-choosing to seek informal and/or formal care (Cauce et al., 2002). While progression through these stages is not always linear, many studies point to the importance of problem recognition-appraisals and perceptions of mental health problems-as it is strongly and positively linked with willingness to seek help and treatment utilization (Godoy et al., 2014;Logan and King, 2002;Oh and Bayer, 2015;Pescosolido et al., 2008;Teagle, 2002;Thurston et al., 2015). Cauce et al. (2002) note that problem recognition can be assessed in two ways: as an objective measure of epidemiologically defined need (e.g., mental health screening, clinical assessments) or as a subjective measure of perceived need (i.e., belief that someone has a mental health problem). ...
... Previous studies reveal several influential factors that contribute to the recognition of problematic adolescent mental health among parents, including the nature of the problem, prior exposure to mental illness, mental health literacy, and familial dynamics. First, severe mental health symptoms may inflict functional impairments in adolescents and substantially burden families, prompting parents to believe their adolescent child is experiencing psychological difficulties (Godoy et al., 2014;King, 2001, 2002;Teagle, 2002). Additionally, although internalizing symptoms are perceived as more severe than externalizing symptoms (Pescosolido et al., 2008), the latter are more identifiable (Thurston et al., 2015). ...
... Additionally, although internalizing symptoms are perceived as more severe than externalizing symptoms (Pescosolido et al., 2008), the latter are more identifiable (Thurston et al., 2015). Second, problem recognition assumes that parents have a working knowledge of the causes of mental disorders (Godoy et al., 2014). Likewise, parents who have personal experience with mental illness (family history of illness/treatment, contact with people with a mental illness) are better able to acknowledge the signs of moderate to severe psychological distress, depression (at both the symptom and disorder level), and diagnosable internalizing/externalizing problems among children/adolescents (Logan and King, 2002;Thurston et al., 2015). ...
Article
Rationale: Parents are one of several key gatekeepers to mental health (MH) services for adolescents with MH problems. Parental MH stigma is a significant barrier to treatment, yet little is known about how stigma may bias parental recognition of mental illness in youth. Objective: This study examines how stigma influences a critical and early stage of the help-seeking process-the recognition of MH problems in preadolescents by their parents. Method: Parents from a school-based anti-stigma intervention study were analyzed. Logistic regressions examined the association of stigma with parental recognition of MH problems in their preadolescent child (10-12 years old) and that of two preadolescent vignette characters described as having bipolar disorder and social anxiety disorder. Results: The more parents desired their preadolescent child to avoid interaction with individuals with a mental illness-that is, to be more socially distant-the less likely these parents believed their child had a MH problem, controlling for parent-reported MH symptoms and other covariates. This pattern was prominent among parents who reported high symptoms in their child. Social distance had no bearing on whether parents recognized the vignette characters as having a problem. Avoidance of individuals with a mental illness and knowledge/positive MH attitudes were not associated with problem recognition. Conclusion: Stigmatizing attitudes of parents may be detrimental when trying to understand the psychopathology of their own preadolescent children but not preadolescents outside their family. Stigma may present itself as a barrier to problem recognition because it may impose a significant personal cost on the family, thereby affecting the help-seeking process earlier than considered by previous work.
... Functional Impairment The Posttraumatic Stress Diagnostic Scale (PDS) (Foa et al. 1997) is a four-part, 49-item self-report measure, assessing trauma history among adults and frequency of posttraumatic stress disorder (PTSD) symptomology due to trauma exposure during the past month. Part IV of the PDS was used to assess levels of daily life impairment among caregivers as related to their trauma exposure. ...
... Caregiver Mental Health Diagnosis-PTS Parts III and IVof the PDS (Foa et al. 1997) were used to assess frequency of PTS symptomology among caregivers. For each item in parts III and IV, caregivers responded from 0 (Bnot at all^) to 3 (Bfive or more times a week^). ...
... However, caregivers' own experiences with trauma may heighten awareness and recognition of mental health needs among their children. In turn, caregiver problem recognition may promote help-seeking attitudes and subsequent treatment utilization (Godoy et al. 2014;Teagle 2002). This interesting finding on trauma history highlights the importance of screening for caregiver trauma history. ...
Article
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This study examined patterns of caregiver factors associated with Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) utilization among trauma-exposed youth. This study included 41 caregivers (caregiver age M = 36.1, SD = 9.88; 93% African American) of youth referred for TF-CBT, following a substantiated forensic assessment of youth trauma exposure. Prior to enrolling in TF-CBT, caregivers reported on measures for parenting stress, attitudes towards treatment, functional impairment, caregiver mental health diagnosis, and caregiver trauma experiences. Classification and regression tree methodology were used to address study aims. Predictors of enrollment and completion included: attitudes towards treatment, caregiver trauma experiences, and parenting stress. Several caregiver factors predicting youth service utilization were identified. Findings suggest screening for caregivers’ attitudes towards therapy, parenting stress, and trauma history is warranted to guide providers in offering caregiver-youth dyads appropriate resources at intake that can lead to increased engagement in treatment services.
... Theoretical models of help-seeking behaviors postulate that parent appraisals of child problems are a central force behind the decision to seek help (Godoy and Carter 2013). Parent decisions to engage in services represent a process marked by several steps, including identifying a problem and ''thinking about'' seeking help before engaging (Godoy et al. 2014). This research suggests that engagement in prevention-versus intervention-programs is inherently challenging because such programs target parents at an early stage of the help-seeking process, and therefore may require more powerful engagement methods. ...
... Due to the general nature of some session content, all topic preferences could be related to what was covered at the session. The program was designed to match parent preferences from a previous survey in the same community (Godoy et al. 2014), which indicated an overall preference for a single, 60-min session. Sessions were designed to accommodate up to eight parents and were held at the same health center from which parents were recruited. ...
... Models of help-seeking behaviors suggest that an individual must first recognize that a problem exists before taking action to seek help (Godoy and Carter 2013); yet for prevention programs, recruitment is made especially challenging by the fact that there may not yet be an apparent problem. Other research has shown that thinking about seeking help mediates the association between parent appraisals of child problems and seeking help (Godoy et al. 2014). In this sense, it is possible that ER may act on some mediator-such as parents' perception of the value of attending-between recruitment and actual attendance. ...
Article
Selective prevention programs hold the promise of alleviating child anxiety symptoms, decreasing the risk for emotional problems across the lifespan. Such programs have particular public health import for young children of poor, underserved communities. Identifying factors related to parent engagement, and methods to improve engagement, are paramount in the effort to develop anxiety-focused, community prevention programs. This feasibility study investigated the effect of an enhanced recruitment strategy to maximize parent engagement, as well as factors related to attendance in a single session focused on anxiety prevention. Participants were poor, ethnic minority parents of children aged 11–71 months (n = 256) who completed a survey that assessed anxiety risk according to trauma exposure, child anxiety, or parent anxiety, as well as preferences for preventive services (phase 1). Those meeting risk criteria (n = 101) were invited to a preventive group session (phase 2). Half of parents received enhanced recruitment (ER), which included personalized outreach, matching parent preferences, and community endorsement. Other parents were invited by mail. Chi square analyses indicated that ER was associated with planning to attend (49 vs. 6 % of control). Parents receiving ER were 3.5 times more likely to attend. Higher sociodemographic risk was correlated with higher child anxiety symptoms but not attendance. Results highlight the need for improved strategies for engaging parents in preventive, community-based interventions.
... These results may reflect the fact that parents' knowledge and appraisal of mental health problems of their children determine their help-seeking behaviour [33,34]. This implies parents' awareness of their children's mental health care needs, but in case of the presence of the parents' own mental illness, this awareness might be lacking, resulting in non or delayed help-seeking [33]. ...
... These results may reflect the fact that parents' knowledge and appraisal of mental health problems of their children determine their help-seeking behaviour [33,34]. This implies parents' awareness of their children's mental health care needs, but in case of the presence of the parents' own mental illness, this awareness might be lacking, resulting in non or delayed help-seeking [33]. CA have a mean delay in help-seeking of about four years [35]. ...
Article
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Background Children of parents with mental illness have a higher risk of developing mental health problems when compared with the general population. Therefore, families with parents with mental illness are a suitable target group for selective prevention. In order to plan and evaluate the health economic consequences of preventive interventions for this target group, data on the societal costs related to parenthood under the condition of mental disorders are needed. To date, within Germany there has been a lack of research evaluating the costs of mental health treatment and use of social services by children and adolescents with parents with mental illness. Methods As part of a multicentre randomised controlled trial, use and costs of health and social services were assessed for a sample of 332 children and adolescents with parents with mental illness in six regions of Germany. Service use at baseline was assessed by the German version of the Children and Adolescent Mental Health Service Receipt Inventory. Costs were calculated for 12 months based on diagnosis and service user status and described separately. Cost drivers were identified by means of a two-part regression model. Results Total mean costs for 12 months for the total sample amount of € 3736.35 (95% CI: € 2816.84–4813.83) per person. Children with a psychiatric diagnosis generated a total of € 5691.93 (95% CI: € 4146.27–7451.38) of costs per person, compared to € 1245.01 (95% CI: € 657.44–1871.49) for children without a psychiatric diagnosis. The logit part indicates significant odds ratios for individual functioning and diagnosis of the child as well as for family functioning. The linear part reveals that increasing individual functioning in the child is related to decreasing costs. Conclusions Children of families with parents with mental illness use a broad spectrum of mental health care, school-based support and youth welfare services even if they are not yet diagnosed as having a mental disorder. Further research should examine whether these institutions are sufficiently qualified and interlinked to meet the support needs of this vulnerable group. Trial registration The study was registered at the 07/10/2014 before the start of data collection (04/11/2014) at the German clinical trials register (Deutsches Register Klinischer Studien, DRKS, nr: DRKS00006806, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006806).
... Recent research on social determinants has further underscored how basic family circumstances impact health and life outcomes (21). However, while adaptive responses to stress during childhood-known as the 'toxic stress response'-can set a pathway toward negative health (20) and life outcomes, there is good news: caring adults can buffer stress and build resilience in children, even in difficult circumstances or when they are burdened with ACEs themselves (13,(22)(23)(24). ...
... • Motivational interviewing (MI) uses patient-centered communication techniques to help individuals work on challenging issues by talking about why they want to change and taking responsibility for their own behaviour. MI can be used to motivate change, raise parent awareness, and elicit specific concerns (2,22,29,30). Key concepts for clinicians using MI are being empathetic, nonjudgmental, and supportive, and a range of training resources is available online (29). ...
Article
A secure attachment relationship with at least one healthy adult is essential for a child to develop optimal coping abilities. Primary care providers like paediatricians and family physicians can help by supporting parents in practice settings. Every clinician encounter is an opportunity to ask parents about children’s relationships and their behaviour, daily routines, and overall family function. This statement, which focuses on children aged 0 to 6 years, describes basic principles in support of positive parenting and recommends in-office practices to promote secure parent–child relationships, engage families and build trust with parents. Crying, sleep, and difficult behaviours are described as opportunities for clinicians to provide anticipatory, responsive guidance to parents.
... Importantly, the caregiver's expectations, attributions, and interpretations of the child's behavior influence their childrearing practices and impact the child's development (Snyder, Cramer, Afrank, & Patterson, 2005). Assessing whether a caregiver is concerned about the child's behavior can clarify: (a) the caregiver's perception of the child's current difficulties, (b) their motivation to seek help (Ellingson, Briggs-Gowan, Carter, & Horwitz, 2004;Godoy & Carter, 2013;Godoy, Mian, Eisenhower, & Carter, 2014), and (c) strategies that may be effective for enhancing buy-in with treatment recommendations (Mian, Godoy, Eisenhower, Heberle, & Carter, 2016). Caregiver perception and concern has implications for intervention targets. ...
... Clinical assessments that include questions about caregiver's concern about the child's behavior can clarify the caregiver's perceptions and motivation to seek help (Ellingson et al., 2004;Godoy & Carter, 2013;Godoy, Mian, et al., 2014). Moreover, the nature of caregiver concerns (e.g., viewing the child as anxious or disruptive) may influence buy-in with specific treatment recommendations (Mian et al., 2016). ...
Chapter
Advances in our understanding of early childhood psychopathology have led to an increase in reliable, valid, and developmentally appropriate rating scales for infants, toddlers, and preschoolers. Caregiver-reported rating scales are helpful to the assessment process because they allow for the standardized gathering of information from the people who know the most about the child’s behavior. In this chapter we discuss the use of adult-report rating scales, including both comprehensive measures and brief screeners, in the clinical assessment of social-emotional and behavioral functioning among children from birth to 5 years of age (“young children”). We review the strengths and limitations of rating scales in clinical assessment, how to select informants and gather information, and the importance of contextual and cultural factors in the selection and interpretation of rating scales. Next we describe the goals and contexts of clinical assessment and how these factors impact the clinical utility of rating scales. We provide guidelines for selecting measures, assessing psychometric properties, and interpreting results. The chapter concludes with a case vignette.
... We chose to include only parents who had children younger than 10 years old at the time of data collection in order for them to have a clear view of this age group in mind. Younger children are more dependent on their parents to seek help on their behalf than older children are, and they are less likely to be sought help for because it is commonly believed that the young children will 'grow out of it' [27,28]. Development from childhood to adolescence occurs on an individual continuum, but 10 years is usually considered a critical point of transition [29,30] with the onset of puberty and its associated hormonal and cognitive changes, combined with a shift from family oriented to peer oriented influences [29]. ...
... The line between normality and mental illness is not clearly defined, leading to variation across ethnic and cultural groups as to what qualifies as mental illness and how it is appropriately handled [34,35]. In our findings, having a 'stubborn' child was a source of worry, and the level of worry has previously been found to predict the initiation of the help-seeking process on behalf of children [27]. However, in the framework for child mental help-seeking called 'The Children's Network Episode Model' (Children's NEM), the concept of 'perceived parental burden' is argued to be a stronger predictor for help-seeking compared to worry [33]. ...
Article
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Background Child mental illness contributes significantly to the burden of disease worldwide, and many are left untreated due to factors on both the provider and user side. Recognising this, the Ugandan Ministry of Health recently released the Child and Adolescent Mental Health (CAMH) Policy Guidelines. However, for implementation to be successful the suggested policy changes must resonate with the service users. To better understand the sociocultural factors influencing parental mental help-seeking, we sought insights from parents in the Mbale district of eastern Uganda. Method In this qualitative study, eight focus group discussions were conducted with mothers and fathers in urban and rural communities. Parents of children younger than 10 years were purposively selected to discuss a vignette story about a child with symptoms of depression or ADHD as well as general themes relating to child mental illness. The data were analysed using qualitative content analysis. Results Descriptions of severe symptoms and epileptic seizures were emphasised when recognising problem behaviour as mental illness, as opposed to mere ‘stubbornness’ or challenging behaviour. A mixture of supernatural, biomedical, and environmental understandings as underlying causes was reflected in the help-seeking process, and different treatment providers and relevant institutions, such as schools, were contacted simultaneously. A notion of weakened community social support structures hampered access to care. Conclusion Awareness of symptoms closer to normal behaviour must be increased in order to improve the recognition of common mental illnesses in children. Stakeholders should capitalise on the common recognition of the importance of the school when planning the upscaling of and improved access to services. Multifactorial beliefs within the spiritual and biomedical realms about the causes of mental illness lead to multisectoral help-seeking, albeit without collaboration between the various disciplines. The CAMH Policy Guidelines do not address traditional service providers or provide a strategy for better integration of services, which might mean continued fragmentation and ineffective service provision of child mental health care. Electronic supplementary material The online version of this article (10.1186/s13034-019-0262-7) contains supplementary material, which is available to authorized users.
... To account for greater complexity, other researchers have defined problem recognition as a multi-dimensional construct incorporating the parent's appraisal of severity, stability, and/or control of the problem into their respective definitions of problem recognition. 25,[75][76][77] For example, a parent can report clinically significant behavior and recognize that the behavior is difficult, but not decide services are warranted because the parent might believe the problems are transient. Breaking down problem recognition into two stages, however, might make predictive models more complex and puts forward a developmental sequence of stages of making appraisals and then assessing service need when it is possible for parents to be doing both simultaneously. ...
... Some models allow for the possibility of non-mental health services, 25,77 while others only include primarily specialty mental health services. 16,42,75 As demonstrated across studies, lack of help-seeking in mental health services does not necessarily indicate an absence of psychopathology, and thus conclusions from studies that only measure mental health service engagement should be interpreted with consideration. Additionally, a common limitation across models is a failure to distinguish between contact with a service and persistence through barriers to remain in treatment, which is a common problem in mental health services. ...
Article
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Millions of children across the USA have unmet mental health needs. When these include the disruptive behavior disorders (DBDs)—oppositional defiant disorder (ODD), conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD)—this can mean significant long-term consequences. Since children rarely seek treatment themselves, parents are central to the help-seeking process. This paper reviews research on the rates of problem recognition and help-seeking for DBDs, and on perceptual barriers that might hinder service engagement. Most children with DBDs are neither identified as such nor engaged in treatment, although this may be less true for ADHD than ODD or CD. Factors associated with DBDs that may reduce service engagement include seeing the behaviors as “normative,” interpreting the symptoms as willful, and expecting to be blamed for the child’s problems. Implications of these findings are discussed with particular focus on the widespread dissemination of evidence-based information about DBDs.
... It may also be related to parents' perception of behavior problems in boys being more accepted than girls and therefore parents feel less of a need to attend a parenting program. Godoy et al. (2014) found that parental appraisal of their child's behavior problems (i.e., perception as problematic and awareness of it) was directly related to help-seeking behavior although no gender difference was found. They also found that parental mental health (stress and depression) was positively associated with parental appraisal and help-seeking behaviors. ...
Article
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Parental engagement in parenting programs is essential for good outcomes but can be challenging for many families. In low- and middle-income countries, where resources are limited and there are fewer support services, there is little research examining the factors that influence engagement. This mixed-methods study explored factors associated with parent engagement, as well as barriers and supports, in a pilot evaluation of a parenting program with 140 parents in North Macedonia, Republic of Moldova, and Romania. The relationship between various quantitative types of engagement (e.g., premature drop-out, participation) and a range of demographic, personal, and implementation factors were examined. Qualitative parent interviews explored barriers and supports to program engagement. Implementation variables (e.g., phone calls with parents, program fidelity and text messages sent to parents) were consistently positively associated with different types of engagement after controlling for other factors. Parents of boys, being a victim of intimate partner violence, more children in the household and better parental well-being were positively associated with premature drop-out whilst having a child enrolled in school was positively associated with participation. Barriers included logistical factors such as timing and lack of childcare facilities. Factors that increased engagement included facilitator skills/support, weekly text messages and phone calls and engagement strategies such as transport and childcare. The results emphasise the importance of implementation factors in increasing parent engagement in parenting programs and will help to inform the next phase of the project as well as other family-support initiatives in the three countries. The trial is registered on ClinicalTrials.gov (ID: NCT03552250).
... Common to many help seeking models is that help seeking first requires an individual to define a problem and recognize a particular behavior as problematic. It also involves the decision to seek help (Broadhurst, 2003;Godoy et al., 2014). The significance of first defining the problem in the help seeking process was also illustrated in research on the barriers in seeking help from mental health services for family member with mental illness (Cheng et al., 2020;Czuchta & McCay, 2001). ...
Article
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Research aimed at understanding the barriers that family members of persons with mental illness may encounter in seeking supportive and preventative services from social workers during the hospitalization of their family member is scarce. Therefore, a cross-sectional survey study was implemented among 120 family members of persons with mental illness in family-centered services in two psychiatric hospitals in Israel. The research instrument included structured questionnaires and open-ended questions examining the barriers to seek help and the experience of families caring for a person with mental illness. The findings indicate that having a person with mental illness in the family may have significant implications on the barriers experienced by family members to seek help for themselves. The extent of the barriers could be related to factors such as the stigma they may experience, overwhelming reactions, lack of knowledge about the mental illness and about the availability of services for families, and dilemmas about seeking help. Social workers are in a key position in psychiatric hospitals to identify and reduce the individual as well as the contextual barriers. To increase family members’ readiness to seek help and their access to early intervention, they should adopt a family-centered approach.
... Parental depression and stress have been shown to affect the way in which parents view their child's behavior, and thus impact subsequent steps in the help-seeking pathway. Specifically, parents with higher levels of depression and stress are more likely to perceive their child's behavior as problematic, and thus are more likely to seek help (Briggs-Gowan & Carter, 2008;Godoy, Mian, Eisenhower, & Carter, 2014). ...
Article
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Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders. Professional practice guidelines recommend combined treatment, psychopharmacological and psychosocial, for youth with ADHD. There have been multiple reviews of pharmacological prescription practices and utilization, however, less is known about predictors of ADHD psychosocial service utilization. Given the importance of accessing psychosocial treatment in relation to improving functional impairment, this review synthesizes evidence on predictors of ADHD psychosocial intervention utilization in clinic, community, and school settings. Eighteen studies were identified and included in the review. Findings are summarized across informant profile factors, predisposing characteristics, and barriers and facilitators. The most robust findings were for the impact of symptom severity/impairment, the presence of comorbidities, and age on ADHD psychosocial service utilization. Race/ethnicity, sex, parental knowledge of the disorder and insurance coverage were also identified as key factors. Future avenues of research are provided, and clinical and policy implications targeted at reducing psychosocial treatment disparities in youth with ADHD are discussed.
... Given the observed delays in at least some developmental domains for children in Profiles 1 and 3, early screening and surveillance efforts are warranted to identify and support children who might not otherwise come to the attention of professionals. Especially for children like those in Profile 3 with few parent-reported behavior problems (i.e., CBCL), their parents might be less likely to seek service [45,46], and thus, these children might be less likely to receive early intervention. Children in Profile 2, the normative functioning class, exhibited average-range abilities across the multiple neurodevelopmental domains measured in the current study. ...
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Objective Children in Flint, Michigan, have experienced myriad sociodemographic adversities exacerbated by the Flint water crisis. To help inform child-focused prevention and intervention efforts, we aimed to describe patterns of neurodevelopmental outcomes among preschoolers who experienced the Flint water crisis before age 2 years. Method Participants were 170 preschoolers who completed a comprehensive neurodevelopmental assessment battery, including directly administered measures of cognitive and executive functioning and maternal-report of adaptive skills and behavioral problems. We used latent profile analysis to derive subgroups. Multivariate multinomial logistic regression was conducted to examine the predictors of profile memberships, including child sex and maternal/family-level factors selected from an array of measured exposures using least absolute shrinkage and selection operator regression. Results Three latent profiles were identified: Profile 1— relative weakness in all domains (50%); Profile 2— normative functioning in all domains (34.1%); and Profile 3— relative strengths in executive function and behavior (15.9%). Profile 1 showed lower scores across cognitive and behavioral domains. Profile 2 demonstrated abilities within the normal range across domains. Profile 3 showed relative strength in executive functioning with few behavior problems, despite lower cognitive performance. Children across all profiles showed adaptive behavior in the adequate range. Child sex and maternal IQ were significant predictors of profile membership. Conclusions Children in Flint demonstrated diverse patterns of development in the face of sociodemographic and environmental adversities. Comprehensive screening and neurodevelopmental profiling of children in this at-risk population are needed to identify areas of needs and inform appropriate service delivery.
... Thus, when parents experience distress in their lives and they perceive that it is interfering with their parenting role, they may be more likely to intend to participate in parenting interventions. Furthermore, when parents experience distress, they may be more aware of their parenting issues, and thus consider seeking help (Godoy et al., 2014). Consistent with previous studies (Chislett & Kennett, 2007;Morawska, Dyah Ramadewi, et al., 2014), findings also supported the last hypothesis regarding the relationship between both formal helpseeking and past participation, and intention to participate. ...
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A wide range of factors, ranging from perceived child behaviour problems to sociocultural factors, have been identified as impacting the engagement of parents in parenting interventions. However, parents’ cognitions and behaviours have not been evaluated sufficiently to understand their role in initial parental engagement. The current study aimed to examine why some parents are more likely to want to participate in parenting programs and how their cognitions and behaviours are related to their intention to participate in future parenting interventions. We tested the hypothesised model of parental factors on intention to participate using structural equation modelling (SEM) in AMOS. This study (N = 6,733) analysed existing data from the International Parenting Survey (IPS), a web-based tool developed to collect information about parents’ views on family and parenting at a population level in several countries. Results showed that parent’s coercive parenting, parental consistency, positive encouragement, relationship with their child, parental self-efficacy, psychological distress, and help-seeking behaviours were significantly related to their intention to participate in future parenting interventions. The structural model of parents’ cognitions and behaviours explained 16% of the variance in intention to participate. Although the current model explained a small but significant percentage of the variance, it expands existing understanding regarding parental cognitions and behaviours and their relationship to intention. Implications for further research and engagement practice are discussed.
... Over the past two decades, annual prevalence rates for mental health disorders among children and adolescents in the United States (U.S.) have remained fairly stable at around 13 to 20% (Perou et al., 2013;Whitney & Peterson, 2019). Despite a growing number of evidence-based interventions that target mental health problems (Godoy et al., 2014;Hodgkinson et al., 2017), only half of children experiencing mental health problems receive care (Whitney & Peterson, 2019). In addition to facing higher rates of mental health needs due to systemic problems (e.g., education, economic, and health disparities) that disproportionately impact marginalized groups (Alegria et al., 2010), the lack of access to acceptable models of mental health care is especially pronounced among underserved sociodemographic groups, including youth from lower socioeconomic status (SES), racial/ethnic minority, limited English language proficient, female, and younger age groups (Irvin et al., 2018;Young & Rabiner, 2015). ...
Article
Unmet behavioral health care needs are especially pronounced among underserved sociodemographic groups based on socioeconomic status, race/ethnicity, English language proficiency, sex, and age. To increase access to care, it is necessary to utilize evidence-based strategies to effectively expand provision of behavioral health services outside of traditional settings to contexts in which help-seeking for child behavioral health care needs is taking place. We retrospectively examined two specific models (consultation and colocation) that comprised an integrated behavioral health program in an inner-city pediatric primary care clinic in order to better understand strategies to feasibly and effectively increase access to care among underserved populations. Results from program evaluation data (that included a sample of 188 patients) support a multi-tiered integrated behavioral health care program of (1) joint consultation encounters delivered by primary care providers (PCPs) and behavioral health clinicians and (2) colocation of behavioral health services. Variations in feasibility, workforce and space considerations, and recommendations for integrating behavioral health programs in inner-city pediatric primary care clinics are discussed.
... In addition to caregiver perceptions of the problem, other factors that influence treatment decision-making include the severity of the problem, child age and gender, social support of the family, service-level characteristics (e.g., bilingual services) and cultural differences in treatment attitudes [18,19]. For instance, African-American parents may be less likely to connect to the school system regarding ADHD problem identification than White parents [20], while barriers to helpseeking behavior, particularly for immigrant families, may include perceived consequences of feeling blamed or potential removal of the child from the family [21]. These barriers may explain why some caregivers recognize that a problem exists but choose not to seek help in school or primary health care settings. ...
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Purpose of review: Limited work has emphasized cultural responsiveness when working with families and children with attention-deficit/hyperactivity disorder (ADHD) from diverse backgrounds. We present a primer for psychiatrists, psychologists, and other mental health professionals on the implementation of culturally responsive practices within a multi-tiered system of support (MTSS) framework when collaborating with schools. Recent findings: Individuals with ADHD demonstrate unique behavioral challenges that affect school and home functioning. As a framework to address the needs of all children with academic and behavioral issues, many public schools have adopted MTSS. Emerging findings on cultural adaptations of evidence-based interventions for ADHD within MTSS are promising. Through a comprehensive tiered approach, this review focuses on (1) initial behavior screening and prevention, (2) implementation of evidence-based interventions tailored to the child's development and family culture, and (3) collaboration between psychiatrists, psychologists, school personnel, and families regarding evaluation of outcomes for children with ADHD, particularly when pharmacological treatment is considered. Engaging in these approaches can promote culturally responsive practices and improve the quality of services provided to children with ADHD.
... Earls et al. 2009). However, given that parent and provider concern strongly predict screening follow-through (Godoy et al. 2014) including in the current sample (Sheldrick et al. 2019), future studies should follow up with children who were not screened to examine whether these age and sex differences reflect biases rather than a true difference in ASD risk. ...
Article
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Health disparities in ASD detection affect children’s access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14–36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.
... Families may perceive their child's mental health issues as transient that their child will "grow out of" and do not warrant services. 39 Lower help-seeking may also reflect lower parental mental health literacy, compared with physical concerns, although the former has potentially higher impact on families. 40 Despite large-scale awareness campaigns and growing dialog, stigma surrounding mental health persists, and parents may fear embarrassment seeking support and choose to self-manage in fear of their child being labelled with a mental health disorder. ...
Article
Objectives To evaluate the utility of universal psychosocial screening in the emergency department (ED) using MyHEARTSMAP, a digital self-assessment and management guiding tool. Study design We conducted a cohort study of youth 10-17 years of age with nonmental health related presentations at 2 pediatric EDs. On randomly selected shifts (December 2017-February 2019), participants completed their psychosocial self-assessments using MyHEARTSMAP on a mobile device, then underwent a standardized clinical mental health assessment (criterion standard). We reported the sensitivity and specificity of respondents’ self-assessment, against a clinician’s standard emergency psychosocial assessment, and the frequency of psychosocial issues and recommended mental health resources identified by screening. Results We approached 1432 eligible youth, among which 795 youth consented to participate (55.5%). Youth and guardians’ sensitivity at self-identifying psychiatric concerns was 92.7% (95% CI 89.1, 95.4%) and 93.1% (95% CI 89.5, 95.8%), respectively. In cases where clinicians had determined to be no psychiatric issues, 98.5% (95% CI 96.7, 99.4%) of youth and 98.9% (95% CI 97.3, 99.7%) of guardians identified the youth as having no or only mild issues. Screening identified 36.4% of youth as having issues in at least 1 psychosocial domain which warranted further follow-up. Conclusions Psychosocial screening in EDs using MyHEARTSMAP can reliably be conducted using the MyHEARTSMAP self-assessment tool and over one-third of screened youth identified issues which can be directed to further care.
... As studies examining mental health care utilization processes in early childhood show wide variations across theoretical models, study designs, measures, and methods, the results are difficult to compare. Studies that have investigated the predictors of parental problem recognition have identified childrelated predictors, such as low reported child social-emotional competence, male sex (Ellingson, Briggs-Gowan, Carter, & Horwitz, 2004), developmental or language delays, and older age of the child as the strongest predictors (Godoy, Carter, Silver, Dickstein, & Seifer, 2014;Godoy, Mian, Eisenhower, & Carter, 2014;Horwitz et al., 2003). If we also consider those studies that focus on actual service use, externalizing behavioural problems 1 also predict service use (Turner & Liew, 2010), presumably moderated through parental impairment and burden (Horwitz et al., 2003;Wichstrom et al., 2014). ...
Article
Unmet mental health needs are common in young children. Recent research on mental health care utilization has focussed mainly on parental perspectives. This study seeks to determine which types of behaviours exhibited by children predict the perceived need for action among both parents and daycare teachers. Parents and daycare teachers reported on problematic behaviours and psychosocial competences among 255 children three to six years of age in Germany. Participants were additionally asked if they perceived a need for action due to the child's behaviour. The results indicate that for parents, Emotional Dysregulation, Speech Problems, and Health and Developmental Problems had predictive power. For daycare teachers, Aggressive Behaviour, Health and Developmental Problems, and the older Age of children predicted the perceived need for action, whereas Social Competence decreased the probability for perceived need. Sensitivity towards the detection of emotional disorders should be increased to improve mental health care utilization.
... Des recherches récentes sur les déterminants sociaux font ressortir encore davantage les conséquences des situations familiales sur la santé et le devenir (21). Cependant, même si les réponses adaptatives au stress pendant l'enfance, qu'on appelle « la réponse au stress toxique », peuvent avoir des conséquences négatives sur la santé (20) et la vie, il y a de bonnes nouvelles : des adultes aimants peuvent assurer une protection contre le stress et renforcer la résilience chez les enfants, même dans des situations difficiles ou lorsque les parents portent eux-mêmes le fardeau d'expériences négatives de l'enfance (13,(22)(23)(24). ...
Article
Résumé Il est essentiel que l’enfant forme des liens d’attachement stables avec au moins un adulte en bonne santé pour développer des capacités d’adaptation optimales. Les professionnels de la santé de première ligne, tels que les pédiatres et les médecins de famille, peuvent y contribuer en soutenant les parents dans leur milieu de pratique. Le clinicien peut profiter de chaque rencontre pour s’informer auprès des parents des relations et des comportements des enfants, des habitudes quotidiennes et du fonctionnement global de la famille. Le présent document de principes, qui porte sur les enfants de 0 à six ans, décrit les principes de base pour soutenir des pratiques parentales positives et recommande des pratiques en cabinet pour promouvoir des relations parents-enfant stables, mobiliser les familles et établir un climat de confiance avec les parents. Les pleurs, le sommeil et les comportements difficiles sont décrits comme des occasions pour le clinicien de donner des conseils préventifs et réceptifs aux besoins des parents.
... It is widely recognised that young children's utilisation of mental health services is highly dependent on parents, as children lack the autonomy and the means to initiate help seeking independently (Boulter & Rickwood, 2013). Parents play a critical role in first identifying their child's problem, opening the gate to services, and maintaining continued receipt of professional help (Godoy, Mian, Eisenhower, & Carter, 2014). Therefore, to clarify and address issues underlying a lack of engagement in professional services, it is critical to examine factors that impact on parents' decisions to seek professional help for their children. ...
Article
For children experiencing emotional and behavioural difficulties, parents are key gatekeepers to treatment access. However, despite the substantial prevalence of child mental health problems in Australia, there remains a significant disparity between the rate of children requiring treatment and the rate of parents actively seeking professional help for their child. Therefore, an understanding of factors impacting on parents’ help-seeking behaviour is crucial. The current study presents exploratory research examining the impact of parent beliefs on help-seeking behaviour. Specifically, this study aims to explore parent beliefs about (a) barriers to help-seeking (b) parenting ability, and (c) the causes and nature of child difficulties. Participants in this study were a sample of 399 Australian parents of children aged from 4 to 14 years, with each parent completing a series of four structured questionnaires. Results indicated that parents who had not sought help for their child perceived significantly more barriers to help seeking and held significantly stronger beliefs that child emotional and behavioural difficulties are intentional. Results also indicated that as parents’ sense of competence increased, perceived barriers to help seeking decreased. Perceived barriers to help seeking also decreased as parent beliefs that child difficulties are stable decreased. The present study presents several implications for informing effective engagement strategies to improve service utilisation, highlighting directions for future hypothesis-driven research.
... Models of parent help-seeking behaviors suggest that the process by which parents seek and receive help starts with parents becoming aware of a problem, being concerned, and thinking about getting help. 28 Pediatricians can play an important role by positively influencing each step of this process, but their responses should depend on where parents are in this help-seeking process. What is needed is often not a discrete answer or recommendation but rather the opening of a discussion, which presents a challenge for brief trainings like this. ...
Article
Pediatric anxiety disorders are highly prevalent, but tend to go undetected as pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of child anxiety disorders. The novel training was completed in a group-based format or via an online, asynchronous training program. Pediatric residents from 2 residency programs (n = 63) participated and completed pre- and posttraining surveys evaluating attitudes about previous training, knowledge about child anxiety, perceived evaluation skills, and responses to clinical vignettes. Most residents (81%) reported they did not receive enough prior training in the presentation of anxiety disorders in young children. Residents’ knowledge and perceived evaluation skills increased posttraining. On the vignette-based assessment, residents demonstrated increased sensitivity with regard to interference, diagnosis, and referral urgency. Despite some challenges with participation, results provide preliminary evidence that brief training programs could be an effective way to improve resident education.
... Consistent with previous evidence (Godoy and Carter 2013;Godoy et al. 2014), results of this study suggest that parents' concerns, providers' clinical judgment, and shared decisionmaking can be important drivers of the detection and diagnosis of ASD. Even in the context of an evidence-based screening protocol, parents' and providers' concerns were more predictive of referral completion than were positive scores on the screener. ...
Article
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U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents’ concerns, providers’ concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.
... Peer delivered, family-to-family (F2F) support-defined as the provision of outreach, engagement, knowledge, care coordination and support to family members of children and youth with mental health challenges-is a rapidly growing and needed component of the service array (Hoagwood et al., 2008;Wisdom et al., 2014). These services evolved from a confluence of several factors: advocacy by families drawing on their own experience in accessing and managing the care of their children (National Federation of Families for Children 's Mental Health, 2017); studies documenting high levels of burden and strain in families and its key role in driving service use (Angold et al., 1998;Godoy, Mian, Eisenhower, & Carter, 2014); the growth of the family-driven care movement (Duchnowski & Kutash, 2007), in which families take on a primary decision-making role (e.g., goal setting, service design, outcome monitoring); and evidence indicating the importance of family involvement in treatment outcomes (Hoagwood et al., 2010). Family support and advocacy is provided through different organizational models in which services are administered through an independent, family-run, nonprofit organization; a mental health provider agency; or a combination of the two (Obrochta et al., 2011). ...
Article
Peer delivered, family-to-family (F2F) support—defined as the provision of outreach, engagement, knowledge, care coordination, and support to family members of children and youth with mental health challenges—is a rapidly growing and needed component of the service array. Progress is occurring toward greater specification of program models and core competencies for the parent support providers (PSPs) with lived experience providing these services; however, strategies to inform quality improvement and ensure accountability are lacking. The Family Journey Assessment (FJA), completed by PSPs and family members, fills this gap by tracking caregiver progress toward self-advocacy and self-efficacy. Analyses of 436 FJAs showed a reliable 3-component structure, reflecting progress in the recognition of needs, collaboration to access help from formal and natural supports, and activation of skills to cope with stress, enhance resilience, and develop and carry out plans of care. PSP feedback provided strong evidence for relevance and usability. Examination of FJAs at baseline and follow-up provides one of the first reports showing significant improvement in key indicators of benefit of F2F for participating families. The FJA holds promise as a measure of the impact of F2F services on key goals and as a way to identify benchmarks for focused and individualized peer-to-peer support depending on the family’s level of need.
... Assessing whether a caregiver is concerned about the child's behavior can clarify the caregiver's perception of the child's current difficulties and his or her motivation to seek help (Ellingson, Briggs-Gowan, Carter, & Horwitz, 2004;Godoy & Carter, 2013;Godoy, Mian, Eisenhower, & Carter, 2014). Furthermore, the nature of caregiver concerns (e.g., viewing the child as disruptive or anxious) may influence buy-in with specific treatment recommendations (Mian et al., 2016). ...
... Maternal life stress and child IC were mean centered prior to analysis. Latent variables for behavior problems at both Time 1 and Time 2 were based on externalizing, internalizing and dysregulation problems (Godoy et al. 2014). Equality constraints were set on the factor loadings, and thresholds were constrained to be equal over time. ...
Article
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The current study examined the links between maternal life stress and subsequent toddler behavior problems and social competence, as well as the potential moderating effects of cool and hot inhibitory control (IC) in mainland China. Participants included 89 mothers and their infants (42 boys, 47 girls). Mothers completed self-report measure of maternal life stress when their children were 1 year of age (M = 1.18, SD = .07 at Time 1), and reported on their children’s social adjustment using the Chinese version of Infant-Toddler Social and Emotional Assessment (CITSEA) at Time 1 and again a year later (M = 2.06, SD = .09 at Time 2). Toddler IC was assessed with laboratory tasks at Time 2. Structural equation modeling with a bootstrap resample of 1000 indicated that cool IC significantly moderated the longitudinal association between maternal life stress (T1) and latent construct of toddler behavior problems (T2), controlling for behavior problems at Time 1, child age and maternal age. Specifically, maternal life stress was associated with subsequent behavior problems only for toddlers who were low in cool IC. In comparison to the results of behavior problems, high levels of maternal life stress predicted subsequent low levels of social competence. Neither cool IC nor hot IC served as the moderator in the association between maternal life stress (T1) and toddler social competence (T2). These findings indicated that toddler cool IC may promote resilient adaptation and modify the links between maternal life stress and toddler behavior problems but not social competence.
... When under financial or social distress, parents may be less sensitive or less apt to notice their child's mental health concerns (Yeh et al., 2005). In either clinical or primary care settings, consultants may consider conducting routine screening of parent well-being, as it is important to examine the effect of parental stress on appraisals of child behavior and parents' willingness to seek help for child behavior problems (Godoy, Mian, Eisenhower & Carter, 2014). This approach may allow consultants to establish rapport, provide resources or alternative sources of support, and understand the cultural context of their decision-making process. ...
Article
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Many immigrant and ethnic minority families demonstrate reluctance to pursue or utilize mental health services in community-based and clinical settings, which often leads to poorer quality of care for children and greater likelihood of early termination. Cultural variations in help-seeking behavior and acculturation are likely to influence consultation participation and process for mental health services. Thus, examining sociocultural context of the consultants, consultees, and clients is critical to the success of multicultural consultation and outcomes. The purpose of the article is to (a) address processes and barriers when engaging in multicultural consultation in community-based and clinical settings, (b) outline the sociocultural context in relation to parent help-seeking behavior, and (c) discuss the effect of acculturation and related sociocultural factors in the participation and process of consultation.
... Neben einer weiteren Sensibilisierung des psychiatrischen Fachpersonals ist somit auch die Sensibilisierung der Eltern für die Belastung ihrer Kinder von Bedeutung. Die Bewertung des kindlichen Verhaltens durch die Eltern steht in engem Zusammenhang mit der Inanspruchnahme von Unterstützungsangeboten [28]. Psychisch kranke Eltern zeigen häufig Unsicherheiten in Bezug auf die Bewertung des Verhaltens ihrer Kinder [29]. ...
Article
Objective The aim of the present study was to assess the health care situation and barriers to support minor children of mentally ill parents from the perspective of adult psychiatry in Germany. Methods Based on the German Hospital Register mental health practitioners of all psychiatric clinics in Germany were asked to answer a 37-item questionnaire. Overall, 441 practitioners of 239 psychiatric clinics participated in the cross sectional study. Results Most important barriers were high workload, scarce resources, patient-focused treatment, missing expertise as well as insufficient awareness. Conclusions More resources, training, clear declaration of competence and coordination of services are necessary to implement family sensitive services in psychiatric clinics. © Georg Thieme Verlag KG Stuttgart · New York.
... CHPs seem to focus more on history or the persistence of problems, whereas current problems (as expressed by the CBCL/ITSEA score) appear to disturb parents the most, which is also reflected in lower parenting efficacy. In particular, this parental burden and appraisal of problems relate to the help-seeking behavior of parents and child mental health services use [33,34]. However, differences in perspectives on child problems can also be caused by reporter bias: e.g. in the present study, parents completed the CBCL/ITSEA and the parenting efficacy scale, whereas the CHPs registered the history of problems and life events. ...
Article
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Background About one third of all parents have concerns about their child’s psychosocial development. Agreement between child health professionals (CHPs) and parents about such concerns may improve treatment adherence and outcomes. This study investigates which child, parenting and/or environmental stressors are associated with (dis)agreement in concerns regarding psychosocial problems in children, in parent-CHP dyads. Methods During routine child health assessments, data were collected from a sample of children aged 14 months to 12 years (n = 3,870). CHPs registered the psychosocial problems that they identified, and parents reported their concerns. Child psychosocial stressors were measured with the ITSEA/CBCL, and the child’s history of psychosocial problems. Environmental stressors referred to stressful family/contextual situations in the past year, and parenting stressors to perceived parenting efficacy. Results The CHPs and parents disagreed on 36.4 % of the children. CHPs based their identification of problems mainly on children’s history of past problem (OR = 5.85, 95 % CI = 4.74–7.22). Parental concerns were most likely in case of an increased ITSEA/CBCL score (OR = 7.69, CI = 5.39–10.97). CHP-parent agreement was more likely in case of a combination of child psychosocial, parenting and environmental stressors (OR = 35.58, CI = 24.11–52.48). Parental concerns not confirmed by the CHP were associated with higher educated parents, originating from an industrialized country, and younger children. The CHP-identified problems not confirmed by parental concerns were associated with older children. Conclusion Agreement between CHPs and parents is associated with a co-occurrence of child, parenting and environmental stressors. Improved agreement between CHP and parents will increase the likelihood of shared decision-making regarding follow-up care and compliance with advice.
... Studies have consistently shown that higher socioeconomic status (7-9), younger child age (10), higher parent education level (11,12), and living in a two-parent household (9,13,14) are associated with retention. Parents' recognition of a psychiatric concern and parent burden resulting from child psychiatric problems are also associated with increased service utilization (15). Several studies have found racial or ethnic minority status to be associated with lower retention rates (9,10,16,17); a few studies, however, have found no effect of race or ethnicity on retention (8,13,18). ...
Article
Objective: The goal of these analyses was to describe the 12-month prevalence of mental health services retention for youths ages six to 12 years and identify predictors of treatment retention. Data were from the Longitudinal Assessment of Manic Symptoms study. Methods: In a longitudinal cohort study, 416 children and their parents completed measures of mental health services use and parents' perception of the services and participated in semistructured psychodiagnostic interviews during a baseline and 12-month assessment. Logistic regression analyses examined the effects on 12-month treatment retention of demographic and clinical variables and parents' perception of how well their children's treatment matched their needs. Results: Sixty-nine percent of youths (N=289) continued to use services at 12 months. After the analyses controlled for other demographic and clinical factors, white race (p<.001) and greater functional impairment (p=.024) were associated with treatment retention; greater perceived treatment match at baseline significantly predicted retention above and beyond the effects of sociodemographic and clinical variables (p=.001). Conclusions: Parents' perceptions about appropriateness of treatment, white race, and functional impairment predicted 12-month treatment retention.
... Several factors may influence parents' preferences for preventive services. Not surprisingly, the severity of child behavior problems and the level of impairment caused by perceived problems correlate with parent help seeking behaviors (Ellingson et al. 2004; Godoy et al. 2014b), and thus likely relate to parents' stated interest in services. Parental perceived relevance—how much parents related to program materials—has been found to be associated with intention to attend a parent-focused prevention program (Mejia et al. 2015). ...
Article
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Dissemination of prevention programs targeting young children is impeded by challenges with parent engagement. Matching program characteristics to parent preferences is associated with increased retention in clinical/intervention settings, but little is known about the types of prevention programs that interest parents. The objectives of this study were to better understand parents' preferences for services designed to prevent externalizing and anxiety disorders and to identify factors associated with preferences. Ethnically diverse, low-income caregivers (n = 485) of young children (11-60 months) completed surveys on child anxiety and externalizing symptoms, parental worry about their children, parent anxiety symptoms, and preferences for prevention group topics. Parents were more likely to prefer a group targeting externalizing behaviors compared to anxiety. Cluster analysis revealed four groups of children: low symptoms, moderate anxiety-low externalizing, moderate externalizing-low anxiety, and high anxiety and externalizing. Parents' preferences varied according to co-occurrence of child anxiety and externalizing symptoms; interest in a program targeting externalizing problems was associated with elevated externalizing problems (regardless of anxiety symptom level), parent anxiety symptoms, and parent worry about their child. Only parent anxiety symptoms predicted parents' interest in an anxiety-focused program, and preference for an anxiety-focused program was actually reduced if children had co-occurring anxiety and externalizing symptoms versus only anxiety symptoms. Results suggest that parents' interest in a program to prevent externalizing problems was well-aligned with the presenting problem, whereas preferences for anxiety programming suggest a more complex interplay among factors. Parent preferences for targeted programming are discussed within a broader framework of parent engagement.
Research
Rana intervencija u djetinjstvu obuhvaća širok spektar postupaka, od rođenja djeteta do polaska u školu, s ciljem poboljšanja zdravlja i dobrobiti djece, njihovih kompetencija, minimiziranja razvojnih teškoća, ublažavanja postojećih teškoća, prevencije funkcionalnog pogoršanja, promoviranja adaptivnog roditeljstva i poboljšanja funkcioniranja obitelji (Pinjatela i Joković Oreb, 2010). Uključuje pružanje podrške obitelji (djeci, njihovim roditeljima te drugim članovima obitelji), informiranje, rehabilitaciju i savjetovanje (Košićek i sur., 2009), u smislu rješavanja problema u vezi zdravstvene skrbi, odgoja i obrazovanja, obiteljskih i društvenih pitanja. Cilj ovog istraživanja bio je utvrditi informiranost, zadovoljstvo i očekivanja roditelja i stručnjaka sustavom usluga rane podrške djeci s teškoćama u razvoju i njihovim obiteljima u Brodsko-posavskoj i Istarskoj županiji, od kojih je Brodsko-posavska na nižem, a Istarska županija na višem stupnju razvijenosti. Uzorak obuhvaća152 roditelja djece s teškoćama u razvoju u dobi od rođenja do polaska u školu i 82 stručnjaka iz područja zdravstva, socijalne skrbi te ranog i predškolskog odgoja i obrazovanja iz Brodsko- posavske i Istarske županije. Korištena su dva mjerna instrumenta koja su osmišljena u svrhu ovog istraživanja (Šarčević Ivić-Hofman, Wagner Jakab i Kiš-Glavaš, 2015). Jedan upitnik namijenjen je roditeljima djece s teškoćama u razvoju, a drugi je namijenjen stručnjacima koji rade s djecom s teškoćama u razvoju i njihovim obiteljima. Važno je istaknuti sljedeće: 1. Rezultati o percipiranoj socijalnoj podršci pokazuju da većina roditelja prima usluge rane podrške, a veću podršku primaju iz formalnih izvora, nego neformalnih izvora mreže podrške. 2. Rezultati o informiranosti roditelja uslugama rane podrške govore da roditelji najviše poznaju i koriste uslugu pedijatra iz doma zdravlja te usluge stručnjaka iz dječjeg vrtića. S obzirom na nalaze regresijske analize, roditelji koji imaju višu stručnu spremu bili su i bolje informirani uslugama rane podrške (ß = .25, p < .01). 3. Rezultati o zadovoljstvu roditelja uslugama rane podrške pokazuju da je najviše roditelja zadovoljno uslugama koje nude dječji vrtići (uključivanje djece s teškoćama u razvoju i savjetodavna podrška stručnjaka, posebno odgojitelja i edukacijskog rehabilitatora) te savjetodavnom podrškom pedijatra iz doma zdravlja. Rezultati regresijske analize pokazali su da se nijedno sociodemografsko obilježje nije pokazalo prediktorom zadovoljstva roditelja uslugama rane podrške. 4. Rezultati o očekivanjima roditelja od usluga rane podrške pokazuju kako su dva sociodemografska obilježja statistički značajno povezana s očekivanjima roditelja o formalnoj podršci, a to su samoprocjena materijalnog stanja i stupanj obrazovanja. 5. Rezultati o informiranosti stručnjaka uslugama rane podrške pokazuju da najviše stručnjaka poznaje savjetodavnu podršku pedijatra iz doma zdravlja te uslugu uključivanja djece s teškoćama u razvoju u dječji vrtić. Rezultati regresijske analize pokazali su da sociodemografska obilježja, samoprocjena educiranosti stručnjaka za rad s djecom s teškoćama u razvoju i samoprocjena znanja o djeci s teškoćama u razvoju nisu se pokazali značajnim prediktorom informiranosti stručnjaka uslugama rane podrške. 6. Rezultati o zadovoljstvu stručnjaka uslugama rane podrške govore da je najviše stručnjaka zadovoljno uslugama savjetodavne podrške pedijatra iz doma zdravlja i uključivanja djece s teškoćama u razvoju u dječji vrtić. Rezultati su pokazali kako stručnjaci koji imaju više znanja o djeci s teškoćama u razvoju bit će zadovoljniji svojom profesionalnom ulogom i podrškom koju pružaju roditeljima djece s teškoćama u razvoju. 7. Rezultati o očekivanjima stručnjaka o doprinosu roditelja, sustručnjaka, institucija i aktera socijalne politike kvaliteti provedbe usluga rane podrške pokazuju da je stručnjacima najvažnija suradnja roditelja sa stručnjacima u svrhu napretka djeteta, pružanje razumljivih informacija roditeljima od strane stručnjaka, odnos temeljen na povjerenju i poštenju te bolja informiranost o uslugama rane podrške i pravima djece s teškoćama u razvoju. Stručnjaci od institucija očekuju omogućavanje pružanja podrške od strane različitih stručnjaka, a od aktera socijalne politike omogućavanje učinkovitog sustava usluga rane podrške već od samog rođenja djeteta i izjednačavanje dostupnosti ustanova, stručnjaka i usluga u velikim urbanim i malim sredinama. Prikupljeni podatci su koristan izvor informacija o informiranosti, zadovoljstvu i očekivanjima uslugama rane podrške od strane i roditelja i stručnjaka.
Article
Objective: Little is known about the factors African American parents consider when seeking care for their child after emotional and behavioral difficulties emerge. This study aimed to examine factors associated with seeking professional care within 30 days after identifying a child's need (i.e., rapid care seeking) and with deferring care for ≥1 year. Methods: This cross-sectional study surveyed African American parents raising a child with emotional or developmental challenges (N=289). Logistic regression was used to examine associations of parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care and deferring care seeking. Results: About 22% of parents rapidly sought care, and 49% deferred care for 1 year or longer. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. Conclusions: Community-based pediatric and child welfare professionals should be informed about facilitators and barriers to mental health care seeking as part of efforts to develop interventions that support African American families.
Article
The objective of this study is to identify the factors that influence the recruitment of parents of at-risk families into prevention programs targeting behavior problems in early childhood. A mixed studies systematic review was performed and the level of evidence for each influencing factor was determined according to the quality of the studies and to the consistency of the results across research. All evidence from the quantitative-, qualitative-, and mixed-design studies were identified (n = 28) using a convergent qualitative synthesis design. The factors that influence parent recruitment were grouped into five broad dimensions, namely, the child, the parent, parent-practitioner interactions, organizational decisions and actions, and policies, which confirms the ecological vision of recruitment. The review highlights the shared responsibility for the recruitment process, some factors being specific not only to the family, but also to the actors involved in the practice. The study demonstrates that certain influencing factors should be further promoted to increase the chances of reaching at-risk families during the early childhood period.
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Caregiver strain and social support have been identified as both facilitators and deterrents to parental mental health service use on behalf of their children. This study focused on the relationship between caregiver strain, social support, and mental health service use among African American mothers of children at-risk or meeting criteria for a disruptive behavioral disorder and living in urban communities of concentrated poverty. Mothers (n = 89), participating in a five-year NIMH funded study of school-based community mental health services, completed measures at baseline of caregiver strain and both perceived and received social support. Service use was calculated as the sum total of services (sessions) received. Associations between caregiver strain and service use were examined, and perceived and received social support were explored as potential moderators. Baseline covariates included child’s age, gender, symptom severity, and maternal employment status. Findings highlighted child symptom severity as the strongest predictor of caregiver strain and perceived social support as moderating the association between caregiver strain and service use. Mothers were more likely to utilize services when experiencing relatively high levels of perceived support or high caregiver strain but not both, highlighting the importance of their interrelationship. Received support did not moderate the association between strain and service use. In addition, mothers utilized services more often for sons than daughters and when unemployed. Implications for research and practice are discussed.
Article
Carers may not always express child mental health concerns to health professionals. Therefore, identifying factors delaying help-seeking is important. The aim of this study was to examine the relationship between carer affect and help-seeking. In a secondary analysis of data collected from school-aged children ( N = 1,857, mean age = 9.85 years, 51% female), we used logistic regression to examine the associations between carer worry, help-seeking and child mental health. Regarding worry, higher levels of emotional problems (OR = 1.42, 95% CI = 1.33–1.52), conduct problems (OR = 1.24, 95% CI = 1.12, 1.36), peer problems (OR = 1.17, 95% CI = 1.05–1.27) or functional impairment (OR = 1.37, 95% CI = 1.2–.56) were associated with higher levels of carer worry. Regarding help-seeking, higher levels of functional impairment were associated with higher levels of help-seeking (OR = 1.51, 95% CI = 1.09–2.11). After controlling for mental health problems, carers who reported being worried about their child’s mental health were less likely than other carers to seek help (OR = 0.13, 95% CI = 0.05–0.35). Knowledge of these factors may inform early interventions. Alongside implications for future research and practice, limitations of the study are discussed.
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Temeljni cilj rada bio je ispitati koliko su roditelji djece s teškoćama u razvoju spremni potražiti socijalno-stručnu pomoć. Prvi specifični cilj bio je tvrditi na koji su način uvjerenja (nepovjerenje, spremnost i nelagoda u traženju socijalno-stručne pomoći) roditelja djece s teškoćama u razvoju o budućem traženju socijalno-stručne pomoći povezana s procijenjenom prethodnom učestalosti dobivene socijalno-stručne podrške i zadovoljstvom prethodno dobivene socijalno-stručne podrške. Drugi specifični cilj je analizirati navedene varijable u odnosu na neka sociodemografska obilježja roditelja i djece (mjesto stanovanja i dob djeteta). Ispitivana su uvjerenja o traženju stručne pomoći te procjena učestalosti i zadovoljstva dobivenom stručnom podrškom kod 102 roditelja djece s teškoćama u razvoju dobi do 15 godina korisnika osam udruga i/ili institucija u kojima su uključeni u odgojno-obrazovni i socijalizacijsko-rehabilitacijski tretman. U trenutku ispitivanja živjeli su u seoskim i urbanim sredinama na području gradova i okolice gradova Rijeke i Vinkovaca. Ukupno su sudjelovale 73 (71.6 %) majke (Mdob = 40.14) i 29 (28.4 %) očeva (Mdob = 41.52). Procijenjena učestalost dobivene socijalno-stručne pomoći i procijenjeno zadovoljstvo dobivenom socijalno-stručnom pomoći su negativno povezani s većim nepovjerenjem prema traženju socijalno-stručne pomoći. Što su djeca starija, to se kod roditelja uočava manje spremnosti za traženje socijalno-stručne pomoći i više nepovjerenja u traženju stručne pomoći. Usporedbom roditelja u Vinkovcima i Rijeci, kao i usporedbom roditelja koji žive u gradu i roditelja koji žive na selu, utvrđeno je da roditelji koji žive u Vinkovcima, kao i roditelji koji žive na selu, iskazuju značajno veću nelagodu u traženju socijalno-stručne pomoći. Autorice se nadaju da rezultati mogu pomoći u budućim istraživanjima teme, kao i u unapređivanju sustavnog pružanja stručne pomoći i podrške obiteljima djece s teškoćama u razvoju. Smatraju da je rad važan u unaprjeđivanju kvalitete socijalno-stručne podrške i pomoći obiteljima djece s teškoćama u razvoju jer ukazuje na teorijski interpretirano nisku roditeljsku procjenu učestalosti i kvalitete dobivene stručne pomoći.
Article
Background The relationship between ethnicity, service use and perceptions of service effectiveness is inconclusive. This study examined differences in service use and perceptions of service effectiveness between Israeli Jewish (Jewish) and Israeli Arab (Arab) parental caregivers of individuals with intellectual disabilities and dual diagnosis of psychopathology. Methods Parental caregivers (n = 186) of individuals with intellectual disabilities or dual diagnosis, aged 10 to 30 years, completed a self‐report questionnaire. Results Arab parental caregivers perceived health services to be more accessible than did Jewish caregivers, but there was no difference between the two groups in the use of the services. Overall, greater enabling factors and accessibility were associated with higher use of education and social services. No differences were found between the groups in their perceptions of service effectiveness. Conclusion Arab family caregivers use education and social services less than do their Jewish peers, possibly because they have fewer enabling resources. The finding that both groups reported similar use of health services may be explained by a shared perception that informal help may not be suitable for dealing with situations of psychopathology. The similar perceptions of service effectiveness may be explained by extensive services available in Israel, to the satisfaction of both groups, or by the fact that participants perceived these services as their only alternative, and therefore fear losing them.
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This study examined the roles of stigma and of enabling factors in help-seeking by parental caregivers of individuals with intellectual disabilities and dual diagnosis. Questionnaires were completed by 195 family caregivers. Lower family stigma was related to higher personal enabling factors (e.g. knowledge about services and previous experience in seeking help), which in turn was related to higher help-seeking behaviors. Higher professional enabling factors (e.g. attitude of the professional, services in the vicinity) were related to higher intentions to seek help, which were related to higher help-seeking behaviors. Professionals can help families achieve a greater sense of self-efficacy in their own help-seeking process by providing them with knowledge about services and facilitating a more positive experience in the process.
Article
Zusammenfassung. Trotz Gefahr der Chronifizierung ist die Inanspruchnahme professioneller Unterstützung beim Vorliegen von psychischen Auffälligkeiten im Kindergartenalter gering. In der vorliegenden Übersichtsarbeit wird die Studienlage zu subjektiven Barrieren aus Elternperspektive sowie zu Prädiktoren der Inanspruchnahme von Unterstützungsmaßnahmen zusammengefasst. Neben äußeren Hindernissen benennen Eltern mangelnde Kenntnisse über das Hilfesystem sowie negative Überzeugungen gegenüber Inanspruchnahme als Barrieren. Als elternbezogene Prädiktoren der Inanspruchnahme zeigen sich v. a. positive Einstellungen bzw. Vorbehalte gegenüber Inanspruchnahme sowie eigenes elterliches Inanspruchnahmeverhalten bei psychischen Schwierigkeiten. Ein höheres Alter der Kinder, die Schwere der Psychopathologie sowie Entwicklungsverzögerungen sind kindbezogene Prädiktoren. Als Hauptprädiktor stellt sich die elterliche Problemerkennung und Sorge heraus. Die Rolle der Fachkräfte in der Kindertagesbetreuung sollte in zukünftigen Studien systematischer berücksichtigt werden.
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Objectives: Children and families enrolled in early childhood systems of care (SOC) present with various psychological and behavioral risk factors that may inhibit healthy development. Within a SOC, wraparound services are designed to increase families' access to numerous child-serving sectors in order to target those risk factors. This study examined whether child and family risk factors at enrollment in an early childhood SOC predicted dosage, service recommendation, and usage of recommended services. Methods: Participants were 144 children ranging in age from 1.38 to 5.89 years and their caregivers. Families completed measures of child and caregiver functioning prior to participation in the SOC. Service recommendation and usage were measured at intake and three months, respectively. We used multiple regression analysis to examine the relationship between risk factors and dosage of services received. Logistic regression analyses identified the relationships between risk factors and service recommendation and usage according to specific service types within the SOC. Results: Children with greater behavior problems received more services overall (R2 = .103, β = .243, p = .033). Child risk factors predicted recommendation for child welfare (trauma exposure: O R ^ = 1.352 , p = .052) and mental health services (behavior problems: O R ^ = 1.061 , p = .034; trauma exposure: O R ^ = 1.316 , p = .046), whereas families with substance use issues were less likely to be recommended for mental health services ( O R ^ = .229 , p = .017). Conclusions: Findings highlight opportunities for improved service provision and service-level decision making in early childhood SOCs.
Article
Intimate partner relationship distress is associated with a wide range of negative adult and child outcomes. The transition to parenthood is often a time in the life of a couple where relationship distress increases and satisfaction and intimacy decrease and thus is an ideal time for targeted intervention. The Healthy Nests (HN) intervention is a three-meeting, strength-focused couples intervention for first-time parents designed to decrease maladaptive relationship conflict and increase couple well-being. The authors conducted a mixed-methods exploratory study investigating participants' overall experiences with the HN intervention and measured outcomes associated with relationship satisfaction, help seeking, father involvement, substance use, and depression. A total of 130 parents (65 dyads) participated in a randomized intervention and educational materials–only alternative intervention. Twenty dyads were interviewed as a part of the qualitative portion of the study. While the authors did not find significant quantitative effects on key outcomes, the qualitative findings suggested that participants had a positive experience with the HN intervention and indicated it was useful to have designated time and space to communicate as a couple. Qualitative findings also suggest that the focus on “aspects of strength” and “areas of change” in their relationship was useful. Implications for practice, research, and training are discussed.
Article
There are a disproportionate number of African American children living in poverty who are in need of mental health services. African American children living in poverty tend to underutilize mental health treatment due to barriers faced by their caregivers; however, far less research has been conducted on the percentage of children who do access mental health treatment, and the experiences of their caregivers in maneuvering through the barriers within their environments. This grounded theory study systematically generated a help-seeking theory that was constructed through the experiences of African American single mothers living in poverty who accessed mental health treatment for their children.
Article
Research has shown that relative caregivers are less likely to use formal supports and services than non-relative foster parents. However, less is known about factors influencing kinship caregivers' help-seeking behaviors and service use. This systematic review identified research studies examining factors associated with service use among kinship caregivers using key search terms in five computerized bibliographic databases and four journals. The search identified 337 potentially relevant studies. After screening and study eligibility assessments, a final sample of 13 studies was reviewed. Findings suggested that although children and their kinship caregivers were clearly in need of services, service use was low. Results suggested a need for more rigorous research designs and that the following factors may influence service use: child behavioral problems, caregiver mental health status, resources, provider characteristics, caregiver perceived need, and social support. More research examining help-seeking behaviors, perceptions of formal services, and effectiveness of kinship caregiver services in relation to child outcomes is needed to improve the wellbeing of kinship families in the child welfare system.
Article
The transition to parenthood is often a time of excitement and pleasure for couples, yet it can also be a time of great stress. Couple distress is associated with significant negative outcomes for parents and children. The Healthy Nests (HN) intervention is a three-meeting, strength focused couples intervention for first-time parents designed to decrease maladaptive relationship conflict and increase couple well-being. We conducted qualitative interviews with ten couples from each condition (n = 20) about their experiences with the HN project. Four categories, twelve themes, and three subthemes were identified across the intervention and control group couple participants. The categories that emerged for the intervention group include: (a) we are partners AND parents and (b) we experienced significant changes. Some subthemes included (a) increased affection and (b) normalized stressors. Implications for practice, research, and training are discussed.
To address the disparities that exist in utilization of mental health services for ADHD among Latino families and to further our understanding of factors that influence parents' decisions to seek treatment for ADHD, the goal of the current study was to examine parental locus of control (PLOC) in a community sample of Latino parents. Specifically, the current study investigated cultural influences on PLOC, as well as the influence of PLOC on help-seeking. Seventy-four primarily Spanish-speaking, Latino parents of school-age children completed measures to assess their help-seeking intentions, PLOC, and cultural orientation. Results indicated that U.S. mainstream orientation was associated with increased feelings of parental control and decreased beliefs in fate/chance and several Latino cultural values were associated with increased beliefs in fate/chance, and decreased feelings of parental efficacy and parental control. In addition, 2 PLOC domains (e.g., parental efficacy and fate/chance) were associated with beliefs that the behaviors of a child with ADHD would go away on their own. Results highlight the need for interventions aimed at modifying parenting behavior to take parents' cultural beliefs and values into account in order to accommodate and engage Latino families more effectively. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Article
Objective: To determine (1) how child age relates to parent concerns about child behavior and (2) how child age and parent concerns correlate with provider referrals and family attendance at mental health consultant (MHC) appointments. Methods: Data were obtained from Rhode Island's Project, Linking Actions for Unmet Needs in Children's Health, in which universal developmental and behavioral screening and MHCs were embedded within primary care sites serving low-income diverse families. Children 9 months to 8 years of age were eligible for the study if they had a scheduled screening well-child visit in 2010 (N = 1451). Families completing screening and/or those referred for a MHC appointment were included in analyses (n = 700). Outcome measures included parent-reported concerns about child behavior, referral status following screening, and family attendance at the MHC appointment. Results: For every 1-month increase in child age, there was a 1.02 times increase in the likelihood of parent behavioral concern and a 1.04 times increase in the likelihood of mental health referral, even when controlling for child behavior. MHC-referred children older than 5 years were 2.61 times more likely to attend than children less than 5 years. When examining parent behavioral concerns and child age jointly, only concerns remained significant. Conclusions: Infants and toddlers, who have the highest rates of unmet mental health needs, may be least likely to benefit from universal screening and on-site MHC support. Efforts to incorporate behaviorally based screening tools and increase parent concerns where appropriate appear warranted, particularly for families with very young children.
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In this article. a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed.
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Seven hundred thirty-one income-eligible families in 3 geographical regions who were enrolled in a national food supplement program were screened and randomized to a brief family intervention. At child ages 2 and 3, the intervention group caregivers were offered the Family Check-Up and linked parenting support services. Latent growth models on caregiver reports at child ages 2, 3, and 4 revealed decreased behavior problems when compared with the control group. Intervention effects occurred predominantly among families reporting high levels of problem behavior at child age 2. Families in the intervention condition improved on direct observation measures of caregivers' positive behavior support at child ages 2 and 3; improvements in positive behavior support mediated improvements in children's early problem behavior.
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Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985, 1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is found to be well supported by empirical evidence. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior. Attitudes, subjective norms, and perceived behavioral control are shown to be related to appropriate sets of salient behavioral, normative, and control beliefs about the behavior, but the exact nature of these relations is still uncertain. Expectancy— value formulations are found to be only partly successful in dealing with these relations. Optimal rescaling of expectancy and value measures is offered as a means of dealing with measurement limitations. Finally, inclusion of past behavior in the prediction equation is shown to provide a means of testing the theory*s sufficiency, another issue that remains unresolved. The limited available evidence concerning this question shows that the theory is predicting behavior quite well in comparison to the ceiling imposed by behavioral reliability.
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The processes by which children with emotional and behavioral disorders seek and obtain help have received little study; yet, they are critical for determining mental health policy and practice. In this article, help-seeking pathways for children are defined and a pathway model is presented. Influences on help-seeking pathways are then reviewed, including illness profile variables, predisposing factors, and barriers to and facilitators of care. Research targets such as the role of informal supports, collateral services, and cultural influences on help-seeking are recommended. Methodological considerations are presented that include assessment of clinically defined mental health need as well as subjective assessment of need, use of complementary qualitative and quantitative methods, and use of cross-system data. The implications for practice and policy of research on help-seeking pathways are described.
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A Monte Carlo simulation study was conducted to investigate the effects on structural equation modeling (SEM) fit indexes of sample size, estimation method, and model specification. Based on a balanced experimental design, samples were generated from a prespecified population covariance matrix and fitted to structural equation models with different degrees of model misspecification. Ten SEM fit indexes were studied. Two primary conclusions were suggested: (a) some fit indexes appear to be noncomparable in terms of the information they provide about model fit for misspecified models and (b) estimation method strongly influenced almost all the fit indexes examined, especially for misspecified models. These 2 issues do not seem to have drawn enough attention from SEM practitioners. Future research should study not only different models vis‐à‐vis model complexity, but a wider range of model specification conditions, including correctly specified models and models specified incorrectly to varying degrees.
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Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: A version Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.
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This study examined outcomes associated with the Family Check-Up (FCU), an adaptive, tailored, family-centered intervention to enhance positive adjustment of middle school youth and prevent problem behavior. The FCU intervention model was delivered to families in 3 public middle schools. The study sample comprised 377 families, and participants were randomly assigned to receive either the intervention or school as usual. Participation in the intervention was relatively high, with 38% of the families receiving the FCU. Participation in the intervention improved youth self-regulation over the 3 years of the study. Self-regulation skills, defined as effortful control, predicted both decreased depression and increased school engagement in high school, with small to medium effect sizes. The results have implications for the delivery of mental health services in schools that specifically target family involvement and parenting skills.
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This technical report reviews and synthesizes the published literature on racial/ethnic disparities in children's health and health care. A systematic review of the literature was conducted for articles published between 1950 and March 2007. Inclusion criteria were peer-reviewed, original research articles in English on racial/ethnic disparities in the health and health care of US children. Search terms used included "child," "disparities," and the Index Medicus terms for each racial/ethnic minority group. Of 781 articles initially reviewed, 111 met inclusion criteria and constituted the final database. Review of the literature revealed that racial/ethnic disparities in children's health and health care are quite extensive, pervasive, and persistent. Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. Mortality-rate disparities were noted for children in all 4 major US racial/ethnic minority groups, including substantially greater risks than white children of all-cause mortality; death from drowning, from acute lymphoblastic leukemia, and after congenital heart defect surgery; and an earlier median age at death for those with Down syndrome and congenital heart defects. Certain methodologic flaws were commonly observed among excluded studies, including failure to evaluate children separately from adults (22%), combining all nonwhite children into 1 group (9%), and failure to provide a white comparison group (8%). Among studies in the final database, 22% did not perform multivariable or stratified analyses to ensure that disparities persisted after adjustment for potential confounders. Racial/ethnic disparities in children's health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health and health care. Methodologic flaws were identified in how such disparities are sometimes documented and analyzed. Optimal health and health care for all children will require recognition of disparities as pervasive problems, methodologically sound disparities studies, and rigorous evaluation of disparities interventions.
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This study addressed why girls are less likely to be referred for mental health services for attention deficit/hyperactivity disorder (ADHD) than boys. Ninety-six parents of children with elevated ADHD symptoms and 140 elementary school teachers read vignettes about children with ADHD. Half of the participants read vignettes with boys' names, and half read the same vignettes but with girls' names. Participants then rated their likeliness to seek or recommend services for the child in each vignette. Parents and teachers were less likely to seek or recommend services for girls than boys with ADHD, but results did not support the hypothesis that this is because girls are less disruptive than boys. Rather, differences in service seeking were explained by the fact that parents and teachers believed that learning assistance is less effective for girls than boys with ADHD.
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The claim that depressed mothers have distorted, inflated, perceptions of their children's problems has been made with increasing frequency in recent years. This review explicates the significance of the depression-->distortion controversy, introduces a set of standards for evaluating distortion claims, and uses these standards to evaluate the key characteristics of 22 studies that have published data directly relevant to the distortion question. None of the studies that claimed evidence for a depression-->distortion influence on mothers' ratings of their children met the necessary and sufficient criteria for establishing distortion. This review challenges the empirical foundation for the widely held assumption that depressed mothers have distorted perceptions of their children's problems. Issues that will require reckoning in future efforts to explore the depression-->distortion question are considered.
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Barriers to participation in treatment were proposed as a basis for dropping out of treatment among children seen in outpatient therapy. Families (N = 242) of children referred for treatment for oppositional, aggressive, and antisocial behavior participated. The main findings were that (a) barriers to participation in treatment contributed significantly to dropping out of therapy; (b) perceived barriers to treatment were not explained by family, parent, and child characteristics that also predicted dropping out; and (c) among families at high risk for dropping out of treatment, the perception of few barriers attenuated risk. Parent perceptions of the difficulties of participating in treatment (including stressors and obstacles associated with treatment, perceptions that treatment is not very relevant, and a poor relationship with the therapist) influenced who dropped out.
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Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.
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This paper explores the use, persistence, and intensity of services for children's mental health problems across a variety of service sectors during a one year period. Data come from the Great Smoky Mountains Study. Analyses focus on children's psychiatric symptomatology and impairment, service use, and factors that may influence the relationship between psychiatric problems and service use across a one year period. Findings show that approximately 20% of children used some mental health services from some sector during the year. Child's symptomatology and characteristics of parents were associated with use and persistence of services. Parent's perceptions of impact on the family were associated with service use, persistence, and intensity.
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A number of studies have consistently found that a mother's mental health (particularly her level of depression) is a strong predictor of mental health problems experienced by her child(ren). However, the validity of this finding is in doubt because the majority of these studies have relied on maternal reports as indicators of children's behavior. This prospective, longitudinal study examines data on the mental health of the mother from prior to the birth of her child to when the child reaches 14 years of age. Child behavior is measured at 14 years of age using reports from mother and child. Mother and child responses are compared to provide an indication of the possible magnitude of maternal observation bias in the reporting of child behavior problems. Anxious and/or depressed mothers tend to report more cases of child behavior problems than do their mentally healthy counterparts or children themselves. Differences between mothers and youths in reporting behavior problems appear to be related to the mothers' mental health. Current maternal mental health impairment appears to have a substantial effect on the reporting of child behavior problems by the mother, thereby raising questions about the validity of reports of child behavior by persons who are currently emotionally distressed.
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The authors examined how well 394 triads of male youths, caregivers, and teachers agreed about youth problems reported on the Achenbach checklists. Dyadic agreement was measured through difference scores (subtracting the raw score of youth self-report from the caregiver's or teacher's score for shared items), q correlations between pairs of raters across items, and D2 (generalized distance between item profiles) for both externalizing and internalizing items. Teachers reported fewer internalizing and externalizing problems than did caregivers or youths. Teacher-youth disagreement was higher for African American than European American males about externalizing criteria. Caregiver depression and stress (but not paternal antisocial behavior or maternal substance abuse) correlated with higher disagreement with other informants about all criteria. These factors appear to increase disagreement about the level of problems but not about specific symptom patterns.
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In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed.
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Results from previous studies examining determinants of parental consultation for child mental health provide inconsistent evidence concerning socio-demographic predictors. The aim of this study is to identify the sociodemographic predictors of parental consultation for child psychological difficulties. An epidemiological cross-sectional analysis was carried out using a sample of 5,913 children aged between 4 and 15 years from the Health Survey for England. The Strengths and Difficulties Questionnaire (SDQ) was the measure of child psychological morbidity. Parents of children with psychological difficulties were less likely to seek a consultation if their child was a girl, as household income decreased or if the head of household came from manual social class. In contrast, parents were more likely to seek a consultation if they were in receipt of a benefit than if they were not in receipt of a benefit. Age of child and family type did not predict parental consultation. The results of this analysis confirm that a substantial proportion of children with mental health difficulties in the general population (42 per cent) have not been seen by a professional, and these are likely to be girls and children in low-income families, indicating a significant unmet need for services across the nation. These results suggest that parents and health professionals should be made more aware of the symptoms of psychological problems in girls and that services need to be planned in a way that improves uptake by low-income parents.
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In this paper the refinement and psychometric properties of the Infant-Toddler Social and Emotional Assessment (ITSEA) are described. Results from a sociodemographically diverse birth cohort sample of 1,235 parents of children between the ages of 12 and 36 months are presented. Confirmatory factor analyses supported the hypothesized Internalizing, Externalizing, Regulatory, and Competence domains as well as the 17 individual scales that comprise the ITSEA. Findings for 3 additional indices useful in identifying significant psychopathology are presented. Subgroup analyses revealed structural invariance and expected mean level differences across both child sex and 6-month age bands. Child sex differences emerged for some problem and most competence scales, with boys rated as higher on Activity/Impulsivity and girls rated higher on Anxiety and most Competence scales. All competence scores increased across age groups. Problem behaviors showed a more mixed developmental pattern. Test-retest and interrater reliability were acceptable. Associations between the ITSEA and independent evaluator ratings and parental ratings of child behavior problems, temperament, and parental distress support the validity of the instrument.
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To determine whether different factors predicted parental recognition of mental health problems in children and use of services for those problems and to determine whether mental health problems elicit service use in the same way as physical health or developmental problems. Survey of the parents of an age- and sex-stratified random sample of children who were born in 1 Connecticut hospital selected from state birth records. Logistic regression results demonstrate that a number of child and family factors are related to problem recognition, defined as thinking about seeking services and/or talking to a professional about a problem. However, factors related to the third outcome of interest-service use-are more limited and include only physical health and developmental problems, parental worry about language, and family conflict. Furthermore, mental health problems were not discussed with professionals, and they were not associated with receipt of services at the same rates as physical health or developmental problems. The correlates of problem recognition (defined as thinking about seeking services or actually speaking to a professional about a problem) differ from those of service use, and, whereas mental health, physical health, and developmental problems all affect problem recognition, mental health problems do not result in service use. Furthermore, rates of service use vary dramatically across the 3 categories. These results suggest that needs alone do not drive service use. Rather, other factors may influence which needs are met.
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A Monte Carlo study was designed to compare the performance of four missing data methods in structural equation models: full information maximum likelihood (FIML), listwise deletion, pairwise deletion, and similar response pattern imputation. The effects of three independent variables were examined (factor loading magnitude, sample size, and missing data rate) on four outcome measures: convergence problems, parameter estimate bias, parameter estimate efficiency, and model goodness-of-fit. The performance of the four estimation methods was assessed in two different simulations. In the first, missing values were missing completely at random (MCAR), while the second simulated missing at random (MAR) data. Results indicated that FIML estimation was superior across all conditions of the design. FIML estimates were unbiased and more efficient than the other methods across both the MCAR and MAR simulations. In addition, FIML yielded the lowest rate of convergence problems and provided near-optimal Type 1 error rates across both simulations. When data were MCAR, pairwise deletion generally yielded satisfactory performance. Parameter estimates were unbiased and convergence rates and efficiency were only slightly worse than FIML. However, inflated Type 1 error rates were observed, particularly when the magnitude of factor loadings was high. However, under MAR pairwise deletion parameter estimates were substantially biased. Both listwise deletion and similar response pattern imputation performed substantially worse than FIML across most conditions of the study. The methods yielded high rates of nonconvergence, and inefficient parameter estimates relative to FIML. These efficiency differences became more pronounced as the missing data rate increased. Under MAR, both methods yielded substantially biased parameter estimates. Although listwise deletion rejection rates were acceptable, those of similar response pattern imputation were substantially inflated. Based on the results of this study, it is recommended that applied researchers discontinue the use of popular ad hoc methods such as listwise and pairwise deletion in favor of FIML.
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Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:593-602), an author’s name was inadvertently omitted from the byline and author affiliations footnote on page 592, and another author’s affiliation was listed incorrectly. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” The author affiliations footnote should have appeared as follows: “Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler; Mss Demler and Walters; and Mr Jin); Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); and Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Rockville, Md (Dr Merikangas).” On page 601, the first sentence of the acknowledgment should have appeared as follows: “The authors appreciate the helpful comments of William Eaton, PhD, and Michael Von Korff, ScD.” Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
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Objective: To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments. Design: The test characteristics of a two-question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression. Setting: Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center. Participants: Five hundred thirty-six consecutive adult patients without mania or schizophrenia. Measurements and main results: Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Book Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89. Conclusions: The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.
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Background: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. Objective: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. Subjects: Data were collected from a random Puerto Rican community sample of caregiver-child dyads. Measures: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. Statistical Methods: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. Results: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified significant predictor, any disruptive disorder diagnosis. Conclusion: Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.