Skip to main content
SpringerLink
Log in

Parental Problem Recognition and Child Mental Health Service Use

  • Published:
Mental Health Services Research

Abstract

This study estimates the prevalence and correlates of two components of problem recognition among parents and assesses their relative effects on child mental health service use in several settings. Analyses were based on data from a population-based sample of 1,420 youth-parent pairs. Child psychopathology and impairment were assessed using the Child and Adolescent Psychiatric Assessment. Problem perception was defined as reporting one or more problems or needs; family impact as reporting one or more impacts. Recent use of 30+ types of mental health services was examined. The frequency of problem perception was 13.3% and family impacts 11.2% across all observations. Among parents of children with 1+ DSM-IV psychiatric diagnosis, 39.0% perceived problems and 31.7% perceived impacts. The strongest predictor of problem perception was impact and vice versa. Problem perception (and not impact) was predictive of specialty services after controlling for child illness. Neither problem recognition component predicted general medical or school use. Findings suggest the need for parent education to help them identify serious problems and for universal screening to ensure that access to specialty services is not dependent solely on parents. Problem recognition should be expanded to include perceptions of other adults in models of access mental health care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Achenbach, T. M. (1991). Manual for the Teacher's Report Form and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Angold, A., & Costello, E. J. (1995). A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C). Psychological Medicine, 25, 755-762.

    Google Scholar 

  • Angold, A., Messer, S. C., Stangl, D., Farmer, E. J., Costello, E. J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88, 75-80.

    Google Scholar 

  • Ascher, B. H., Farmer, E. M. Z., Burns, B. J., & Angold, A. (1996). The Child and Adolescent Services Assessment (CASA): Description and psychometrics. Journal of Emotional and Behavioral Disorders, 4, 12-20.

    Google Scholar 

  • Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The Caregiver Strain Questionnaire: Measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5, 212-222.

    Google Scholar 

  • Burns, B. J., Angold, A., Magruder-Habib, K., Costello, E. J., & Patrick, M. K. S. (1992). The Child and Adolescent Services Assessment (CASA) (Version 3.0). Durham, NC: Duke University Medical Center.

    Google Scholar 

  • Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M. Z., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147-159.

    Google Scholar 

  • Cohen, P., & Hesselhardt, C. S. (1992). Demographic factors in the use of children's mental health services. American Journal of Public Health, 82, 49-52.

    Google Scholar 

  • Costello, E. J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L., Erkanli, A., & Worthman, C. M. (1996). The Great Smoky Mountains study of youth: Goals, design, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry, 53, 1129-1136.

    Google Scholar 

  • Costello, E. J., Angold, A., March, J., & Fairbank, J. (1998b). Life events and post-traumatic stress: the development of a new measure for children and adolescents. Psychological Medicine, 28, 1275-1288.

    Google Scholar 

  • Costello, E. J., Pescosolido, B. A., Angold, A., & Burns, B. J. (1998). A family network-based model of access to child mental health services. Research in Community Mental Health, 9, 165-190.

    Google Scholar 

  • Cunningham, P. J., & Freiman, M. P. (1996). Determinants of ambulatory mental health services use for school-age children and adolescents. Health Services Research, 31, 409-427.

    Google Scholar 

  • Diggle, P. J., Liang, K., & Zeger, S. L. (1994). Analysis of Longitudinal Data. Oxford: Clarendon.

    Google Scholar 

  • Dulcan, M. D., Costello, E. J., Costello, A. J., Edelbrock, C., Brent, D., & Janiszewski, S. (1990). The pediatrician as gatekeeper to mental health care for children: Do parents' concerns open the gate? Journal of the American Academy of Child and Adolescent Psychiatry, 29, 453-458.

    Google Scholar 

  • Farmer, E. M. Z., Burns, B. J., & Angold, A. (1997). Impact of children's mental health problems on families: Effects on services. Journal of Emotional and Behavioral Disorders, 5, 230-238.

    Google Scholar 

  • Flisher, A.J., Kramer, R.A., Grosser, R.C., Alegria, M., Bird, H.R., Bourdon, K.H., Goodman, S.H., Greenwald, S., Horwitz, S.M., Moore, R.E., Narrow, W.E., Hoven, W. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27, 1145-1154.

    Google Scholar 

  • Gall, G., Pagano, M.E., Desmond, S., Perrin, J.M., Murphy, J.M. (2000). Utility of psychosocial screening at a school-based health center. Journal of School Health, 70, 292-298.

    Google Scholar 

  • Garralda, M. E., & Bailey, D. (1988). Child and family factors associated with referral to child psychiatrists. British Journal of Psychiatry, 153, 81-89.

    Google Scholar 

  • Griest, D. L., Foreland, R., Wells, K. C., & McMahon, R. J. (1980). An examination of differences between nonclinic and behavior-problem clinic-referred children and their mothers. Journal of Abnormal Psychology, 89, 497-500.

    Google Scholar 

  • Griffin, J. A., Cicchetti, D., & Leaf, P. J. (1993). Characteristics of youths identified from a psychiatric case register as first-time users. Hospital and Community Psychiatry, 44, 62-65.

    Google Scholar 

  • Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.

    Google Scholar 

  • Jensen, P. S., Bloedau, L., & Davis, H. (1990). Children at risk II: Risk factors and clinic utilization. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 804-812.

    Google Scholar 

  • John, L. H., Offord, D. R., Boyle, M. H., & Racine, Y. A. (1995). Factors predicting use of mental health and social services by children 6-16 years old: Findings from the Ontario Child Health Study. American Journal of Orthopsychiatry, 65, 76-85.

    Google Scholar 

  • 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, 889-897.

    Google Scholar 

  • Messer, S. C., Angold, A., Costello, E. J., Burns, B. J., Farmer, E. M. Z., & Patrick, M. K. S. (1996). The Child and Adolescent Burden Assessment (CABA): Measuring the family impact of emotional and behavioral problems. International Journal of Methods and Psychiatric Research, 6, 261-284.

    Google Scholar 

  • Murphy, J. M., Ichinose, C., Hicks, R. C., et al. (1996). Utility of the Pediatric Symptom Checklist as a psychosocial screen to meet the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards: A pilot study. Journal of Pediatrics, 129, 864-869.

    Google Scholar 

  • Offord, D. R., Boyle, M. H., Szatmari, P., Rae-Grant, N., Links, P. S., Cadman, D. T., et al. (1987). Onatrio child health study: II. Sixmonth prevalence of disorder and rates of service utilization. Archives of General Psychiatry, 44, 832-836.

    Google Scholar 

  • Patrick, M., Angold, A., Burns, B. J., & Costello, E. J. (1992). The Child and Adolescent Burden Assessment (CABA). Durham, NC: Duke University Medical Center, Department of Psychiatric and Behavioral Sciences, Developmental Epidemiology Program.

    Google Scholar 

  • SAS Institute. (1997). SAS/STAT software: Changes and enhancements through release 6.12. Cary, NC: Author.

    Google Scholar 

  • Staghezza-Jaramillo, B., Bird, H. R., Gould, M. S., & Canino, G. (1995). Mental health service utilization among Puerto Rican children ages 4 through 16. Journal of Child and Family Studies, 4, 399-418.

    Google Scholar 

  • Stiffman, A. R., Hadley-Ives, E., Dore, P., Polgar, M., Horvath, V. E., Striley, C., et al. (2000). Youths' access to mental health services: The role of providers' training, resource connectivity, and assessment of need. Mental Health Services Research, 2, 141-154.

    Google Scholar 

  • Stiffman, A. R., Striley, C., Horvath, V. E., Hadley-Ives, E., Polgar, M., Elze, D., et al. (2001). Organizational context and provider perception as determinants of mental health service use. Mental Health Services Research, 28, 188-204.

    Google Scholar 

  • Teagle, S., Angold, A., & Costello, E. J. (1999). Effect of parental impact on mental health service use across service sectors. In Liberton, C. J. Newman, C. Kutash, K. Friedman, R. M. (Eds.), 12th Annual Proceedings: A system of care for children's mental health: Expanding the research base (pp. 137-140). Tampa, FL: University of South Florida, February 2000.

    Google Scholar 

  • Verhulst, F. C., & Van Der Ende, M. S. (1997). Factors associated with child mental health service use in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 901-909.

    Google Scholar 

  • Wu, P., Hoven, C. W., Bird, H. R., Moore, R. E., Cohen, P., Alegria, M., et al. (1999). Depressive and disruptive disorders and mental health service utilization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1081-1090.

    Google Scholar 

  • Zahner, G. E. P., & Daskalakis, C. (1997). Factors associated with mental health, general health, and school service use for child psychopathology. American Journal of Public Health, 87, 1440-1448.

    Google Scholar 

  • Zahner, G. E. P., Pawelkiewicz, W., DeFrancesco, J. J., & Adnopoz, J. (1992). Children's mental health service needs and utilization patterns in an urban community: An epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 951-960.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Risk Behavior and Mental Health Research, Division of Health, Social and Economic Research, Research Triangle Institute, 3040 Cornwallis Road (Cox 2 Bldg, Room 361), Research Triangle Park, North Carolina, 27709

    Sarah E. Teagle

Authors
  1. Sarah E. Teagle
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Teagle, S.E. Parental Problem Recognition and Child Mental Health Service Use. Ment Health Serv Res 4, 257–266 (2002). https://doi.org/10.1023/A:1020981019342

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1020981019342

Search

Navigation