Abstract
The present study investigated parental endorsement of barriers to care in a racially/ethnically diverse, at-risk sample of youth with mental health needs by testing the following hypotheses: (1) African American, Asian/Pacific Islander American, and Latino youth would have higher levels of unmet need compared to Non-Hispanic Whites (NHWs); (2) Parents of ethnic minority youth would report a greater number of barriers to mental health services for their children than would parents of NHWs; (3) The pattern of greater barrier endorsement by parents of ethnic minorities compared to parents of NHWs would persist across different barrier types; (4) Barrier endorsement would be related to unmet need for mental health services. As hypothesized, ethnic minority youth had higher levels of unmet need as compared to NHWs. However, despite this finding, parents of ethnic minority youth reported fewer barriers than did parents of NHWs, and this pattern generally persisted across barrier types. Furthermore, barrier endorsement was unrelated to unmet need. Post hoc analyses suggest the influence of cultural factors upon barrier endorsement, indicating the importance of taking such influences into account in future research on barriers to care.
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Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.
Achenbach, T. M. (1991b). Manual for the Youth Self-Report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.
Bird, H. R., Canino, G., Rubio-Stipec, M., & Ribera, J. C. (1987). Further measures of the psychometric properties of the Children's Global Assessment Scale. Archives of General Psychiatry, 44, 821-824.
Bird, H. R., Shaffer, D., Fisher, P., Gould, M. S., Staghezza, B, Chen, J. Y., et al. (1993). The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167-176.
Bui, K.-V. T., & Takeuchi, D. T. (1992). Ethnic minority adolescents and the use of community mental health care services. American Journal of Community Psychology, 20, 403-417.
Burnam, M. A., Telles, C., & Karno, M. (1987). Measurement of acculturation in a community population of Mexican Americans. Hispanic Journal of Behavioral Sciences, 9, 105-130.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M. Z., et al. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147-159.
Chan, S. (1998). Families with Asian roots. In E. W. Lynch & M. J. Davis (Eds.), Developing cross cultural competence (2nd ed., pp. 251-354). Baltimore: Paul H. Brooks.
Chavez, J. M., & Roney, C. E. (1990). Psychocultural factors affecting the mental health status of Mexican American adolescents. In A. R. Stiffman & L. E. Davis (Eds.), Ethnic issues in adolescent mental health (pp. 73-91). Newbury Park: Sage.
Cuellar, I., Harris, L. C., & Jasso, R. (1980). An acculturation scale for Mexican American normal and clinical populations. Hispanic Journal of Behavioral Sciences, 2, 199-217.
Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: Patterns of care for children's mental health across one year. Community Mental Health Journal, 35(1), 31-46.
Flisher, A. J., Kramer, R. A., Grosser, R. C., Alegria, M., Bird, H. R., Bourdon, K. H., et al. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27(5), 1145-1154.
Flores, G., Abreu, M., Olivar, M. A., & Kastner, B. (1998). Access barriers to health care for Latino children. Archives of Pediatrics and Adolescent Medicine, 152, 1119-1125.
Garland, A. F., Hough, R. L., McCabe, K. M, Yeh, M., Wood, P. A, & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry, 40(4), 409-418.
Henry, G. T. (1990). Practical sampling. Newbury Park: Sage.
Hoagwood, K., Horwitz, S., Stiffman, A., Weisz, J., Bean, D., et al. (2000). Concordance between parent reports of children's mental health services and service records: The Services Assessment for Children and Adolescents (SACA). Journal of Child and Family Studies, 9, 315-331.
Hoberman, M. (1992). Ethnic minority status and adolescent mental health services utilization. Journal of Mental Health Administration, 19(3), 246-267.
Horwitz, S. M., Hoagwood, K., Stiffman, A. R., Weisz, J. R., Costello, E. J., Rost, K., et al. (2001). Reliability of the services assessment for children and adolescents. Psychiatric Services, 52, 1088-1094.
Leaf, P. J., Alegria, M., Cohen, P. Goodman, S. H., Horwitz, S. M., Hoven, C. W., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889-897.
Leong, F. T. L, Wagner, N. S., & Tata, S. P. (1995). Racial and ethnic variations in help-seeking attitudes. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 428-432). Thousand Oaks, CA: Sage.
Mansour, M. E., Lanphear, B. P., & DeWitt, T. G. (2000). Barriers to asthma care in urban children: Parent perspectives. Pediatrics, 106(3), 512-519.
Martinez, C. (1993). Psychiatric care of Mexican Americans. In A. C. Gaw (Ed.), Culture, ethnicity, and mental illness (pp. 431-466). Washington, DC: American Psychiatric Press.
McCabe, K., Yeh, M., Hough, R. L., Landsverk, J., Hurlburt, M. S., Culver, S. W., et al. (1999). Racial/ethnic representation across five public sectors of care for youth. Journal of Emotional and Behavioral Disorders, 7, 72-82.
McNeil, J. S., & Kennedy, R. (1997). Mental health services to minority groups of color. In T. R. Watkins & J. W. Callicutt (Eds.), Mental health policy and practice today (pp. 235-257). Thousand Oaks, CA: Sage.
Mendoza, R. H., & Martinez, J. L. (1981). The measurement of acculturation. In A. BarenJr. (Ed.), Explorations in Chicano psychology (pp. 21-82). New York: Holt.
National Institute of Mental Health. (2000). Strategic plan for reducing health disparities. Retrieved December 20, 2000, from www.nimh.nih.gov/strategic/strategicdisparity.cfm/
Ortega, A. N., Rosenheck, R., Alegria, M., & Desai, R. A. (2000). Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. The Journal of Nervous and Mental Disease, 188, 728-735.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
Radloff, L. S., & Teri, L. (1986). Use of the Center for Epidemiological Studies—Depression Scale with older adults. Clinical Gerontologist, 5(1/2), 119-136.
Rao, J. N. K., & Scott, A. J. (1981). The analysis of categorical data from complex sample surveys: Chi-squared tests for goodness of fit and independence in two way tables. Journal of the American Statistical Association, 76, 221-230.
Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M. E., et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865-877.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28-38.
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A Children's Global Assessment Scale (CGAS). Archives of General Psychiatry, 40, 1228-1231.
Soriano, F. (1999). Pan-Acculturation Scale. Unpublished manuscript, California State University, San Marcos, California.
Soriano, F. I., & Hough, R. L. (2000). New developments in acculturation measurement: An introduction to the Pan-Accculturation Scale. Unpublished manuscript, Child and Adolescent Services Research Center, Children's Hospital, San Diego, California.
Stefl, M. E., & Prosperi, D. C. (1985). Barriers to mental health utilization. Community Mental Health Journal, 21(3), 167-178.
Stiffman, A. R., Horwitz, S. M., Hoagwood, K., Compton, W., Cottler, L., Bean, D. L., et al. (2000). The Service Assessment for Children and Adolescents (SACA): Adult and child reports. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1032-1039.
Sue, S. (1994). Mental health. In N. W. S. Zane, D. T. Takeuchi, & K. N. J. Young (Eds.), Confronting critical health issues of Asian and Pacific Islander Americans (pp. 266-288). Thousand Oaks, CA: Sage.
Takeuchi, D. T., Leaf, P. J., & Kuo, H. (1988). Ethnic differences in the perception of barriers to help-seeking. Social Psychiatry and Psychiatric Epidemiology, 23, 273-280.
Uba, L. (1994). Asian Americans: Personality, patterns, identity, and mental health. New York: The Guilford.
UNOCCAP Work Group. (1996). Service Assessment for Children and Adolescents. Unpublished measure.
U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity: A report of the surgeon general. Rockville, MD: Author.
Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771-778.
Vraniak, D. A., & Pickett, S. (1993). Improving interventions with American ethnic minority children: Recurrent and recalcitrant challenges. In T. R. Kratochwill & R. J. Morris (Eds.), Handbook of psychotherapy with children and adolescents (pp. 502-539). Boston, MA: Allyn and Bacon.
Weech-Maldonado, R., Morales, L. S., Spritzer, K., Elliott, M., & Hays, R. D. (2001). Racial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care. Health Services Research, 36, 575-594.
Woodward, A. M., Dwinell, A. D., & Arons, B. S. (1992). Barriers to mental health care for Hispanic Americans: A literature review and discussion. Journal of Mental Health Administration, 19(3), 224-236.
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Yeh, M., McCabe, K., Hough, R.L. et al. Racial/Ethnic Differences in Parental Endorsement of Barriers to Mental Health Services for Youth. Ment Health Serv Res 5, 65–77 (2003). https://doi.org/10.1023/A:1023286210205
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DOI: https://doi.org/10.1023/A:1023286210205