Abstract
Enhancing the functioning of parents, teachers, juvenile justice authorities, and other health and mental heal professionals who direct children and adolescents to services is a major mental health services concern. The Gateway Provider Model is an elaborated testable subset of the Network-Episode Model (NEM; B. A. Pescosolido & C. A. Boyer, 1999) that synthesizes it with Decision (D. H. Gustafson, et al., 1999) and organizational theory (C. Glisson, 2002; C. Glisson & L. James, 1992, 2002). The Gateway Provider Model focuses on central influences that affect youth's access to treatment, i.e., the individual who first identifies a problem and sends a youth to treatment (the “gateway provider”); and the need those individuals have for information on youth problems and relevant potential resources. Preliminary studies by the authors and other applicable studies (D. Carise & O. Gurel, 2003) show that providers' perception of need, and their knowledge of resources, and their environment are related to the decision to offer or refer to services, supporting key aspects of the Model.
Similar content being viewed by others
REFERENCES
Albert, D. A. (1978). Decision theory in medicine: A review and critique. Health and Society, 56(3), 362–401.
Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D., et al. (2002) Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services, 53(12), 1547–1555.
Alegria, M., Robles, R., Freeman, D. H., Vera, M., Jimenez, A. L., Rios, C., et al. (1991). Patterns of mental health utilization among island Puerto Rican poor. American Journal of Public Health, 8, 875–879.
Andersen, R. M. (1968). Behavioral model of family's use of health services: Research series, 25. Chicago, IL: University of Chicago, Center for Health Administration Studies.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10.
Armstrong, D., Bird, J., Fry, J., & Armstrong, P. (1992). Perspectives of psychological problems in general practice: A comparison of general practitioners and psychiatrists. Family Practice, 9(2), 173–176.
Ashkanasy, N. M., Broadfoot, L. E., & Falkus, S. (2000). Questionnaire measures of organizational culture. In N. M. Ashkanasy, C. P. M. Wilderom, & M. F. Peterson (Eds.), Handbook of organizational culture and climate (pp. 131–146). Thousand Oaks, CA: Sage.
Becker, M. H., & Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations. Medical Care, 13(1), 10–24.
Bickman, L., Heflinger, C. A., Northrup, D., Sonnischsen, S., & Schilling, S. (1998). Long term outcomes to family caregiver empowerment. Journal of Child and Family Studies, 7, 269–282.
Brown, S. P., & Leigh, T. W. (1996). A new look at psychological climate and its relationship to job involvement, effort, and performance. Journal of Applied Psychology, 81, 358–368.
Burns, B. J., & Friedman, R. M. (1990). Examining the research base for child mental health services and policy. Journal of Mental Health Administration, 17, 87–98.
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.
Bush, P. J., & Iannotti, R. J. (1990). A children's health belief model. Medical Care, 28(1), 69–83.
Carise, D., & Gurel, O. (2003). Benefits of integrating technology with treatment: The DENS Project. In J. Sorenson, R. Rawson, J. Guydish, & J. Zweben (Eds.). Drug abuse treatment through collaboration: Practice and research partnerships at work (pp. 181–195). Washington, DC: American Psychological Association.
Chapman, G. B., & Sonnenberg, F. A. (2000). Decision making in health care: Theory, psychology, and applications. New York: Cambridge University Press.
Commander, M. J., Dharan, S. P., Odell, S. M., & Surtees, P. G. (1997). Access to mental health care in an inner-city health district. II: Association with demographic factors. British Journal of Psychiatry, 170, 317–320.
Cooke, R. A., & Szumal, J. L. (1993). Using the organizational culture inventory to understand the operating cultures of organizations. In N. M. Ashkanasy, C. P. M. Wilderom, & M. F. Peterson (Eds.), Handbook of organizational culture and climate (pp. 147–162). Thousand Oaks, CA: Sage.
Costello, E. J., Burns, B. J., Angold, A., & Leaf, P. J. (1993). How can epidemiology improve mental health services for children and adolescents? Journal of the American Academy of Child and Adolescent Psychiatry, 32(6), 1106–1115.
Costello, E. J., Burns, B. J., Costello, A. J., Edelbrock, C., Dulcan, M., & Brent, D. (1988). Service utilization and psychiatric diagnosis in pediatric primary care: The role of the gatekeeper. Pediatrics, 82(3/2), 435–441.
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 and Mental Health: Social Networks and Mental Illness, 9, 165–190.
Creed, F., Gownsunkur, J., Russell, E., & Kincey, J. (1990). General practitioner referral rates to district psychiatry and psychology services. British Journal of General Practice, 40, 450–454.
Earls, F. J., Robins, L. N., Stiffman, A. R., & Powell, J. (1989). Comprehensive health care for high-risk adolescents: An evaluation study. American Journal of Public Health, 79, 999–1005.
Eddy, D. M. (1996). Clinical decision making from theory to practice: A collection of essays from the Journal of the American Medical Association. Sudbury, MA: Jones and Bartlett.
Edwards, W., & Fasolo, B. (2001). Decision technology. Annual Review of Psychology, 581–605.
English, A. (1986). Adolescent health care: Barriers to access: Consent, confidentiality, and payment. Clearinghouse Review, Summer, 481–490.
Farmer, A. E., & Griffiths, H. (1992). Labeling and illness in primary care: Comparing factors influencing general practitioners' and psychiatrists' decisions regarding patient referral to mental illness services. Psychological Medicine, 22,717–723.
Fishbein, M., & Azjen, I. (1975). Belief, attitude, intention and behavior. Reading, MA: Addison-Wesley.
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 children and adolescents. Psychological Medicine (QER), 27, 1145–1154.
Friedman, R. M. (1986). Major issues in mental health services for children. Sixth annual meeting of the American College of Mental Health Administration, (San Diego, California). Administration in Mental Health, 14(1), 6–13.
Gater, R., De Almeida, B., Sousa, E., Barrientos, G., Caraveo, C., Chandrashekar, C., et al. (1991). The pathways to psychiatric care: A cross-cultural study. Psychological Medicine, 21, 744–761.
Gerbert, B., Bronston, A., Maurer, T., Hofmann, R., & Berger, T. (1999). Decision support software to help primary care physicians triage skin cancer: A pilot study. Archives of Dermatology, 135, 187–192.
Glisson, C. (2002). The organizational context of children's mental health services. Clinical Child and Family Psychology Review, 5(4), 233–253.
Glisson, C., & Hemmelgarn, A. (1998). The effects of organizational climate and interorganizational coordination on the quality and outcomes of children's service systems. Child Abuse and Neglect, 22(5), 401–421.
Glisson, C., & James, L. (1992). The interorganizational coordination of services to children in state custody. Administration in Social Work, 16(3/4), 65–79.
Glisson, C., & James, L. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23(6), 1099–1379.
Goldberg, D. (1984). The recognition of psychiatric illness by non-psychiatrists. Australian and New Zealand Journal of Psychiatry, 18, 128–133.
Goldberg, D. P., & Huxley, P. (1980). The pathway to psychiatric care. London: Tavistock Press.
Gustafson, D. H., Hawkins, R., Boberg, E., Pingree, S., Serlin, R. E., & Graziano, F. (1999). Impact of a patient-centered, computer-based health information/support system. American Journal of Preventative Medicine, 16(1), 1–9.
Hammer, J. S., Strain, J. T., & Lyons, J. S. (1991). Health service delivery and research outcomes of a common departmental structure for psychiatric consultation-liaison and social work services at a university hospital. General Hospital Psychiatry, 13, 95–105.
Hatcher, L. (1994). A step by step approach to using the SAS System for factor analysis and structural equations modeling. Cary, NC: SAS Institute, Inc.
Hatfield, B., Harrington, R., & Mohamad, H. (1996). Staff looking after children in local authority residential units: The interface with child mental health professionals. Journal of Adolescence, 19, 127–139.
Hoge, M. A., & Howenstine, R. A. (1997). Organizational development strategies for integrating mental health services. Community Mental Health Journal, 33, 175–187.
Hohmann, A. A. (1999). A contextual model for clinical mental health effectiveness research. Mental Health Services Research, 1, 83–91.
Hollingshead, A. B. (1975). Four factor index of social status.New York: Wiley.
Horwitz, S. M., Leaf, P. J., Leventhal, J. M., Borsyth, B., & Speechley, K. N. (1992). Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics, 89, 480–485.
James, L. R., James, L. A., & Ashe, D. K. (1990). The meaning of organizations: The role of cognition and values. In B. Schneider (Ed.), Organizational climate and culture (pp. 40–84). San Francisco: Jossey Bass.
Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly,11(1), 1–47.
Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderline between anthropology, medicine and psychiatry. Berkeley, CA: University of California Press.
Kopelman, R. E., Brief, A. P., & Guzzo, R. A. (1990). The role of climate and culture in productivity. In B. Schneider (Ed.) Organizational climate and culture (pp. 282–318). San Francisco: Jossey-Bass.
Kvedar, J. C. (2000). Decision support is changing health care. Archives of Dermatology, 136, 249.
Landsverk, J. (1995). Design and assessment issues in conducting longitudinal outcome studies of children in welfare systems. In T. Vecchiato (Ed.), Social research methods for the evaluation of social services (pp. 52–65). Padua: Fondazione Emanuela Zancan.
Lourie, I. S., & Katz-Leavy, J. (1991). New directions for mental health services for families and children. Families in Society: The Journal of Contemporary Human Services, May 277–285.
McLafferty, S., & Broe, D. (1990). Patient outcomes and regional planning of coronary care services: A location-allocation approach. Social Sciences and Medicine, 30(3), 297–304.
Mechanic, D. (1979). Correlates of physician utilization: Why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects? Journal of Health and Social Behavior, 20, 387–396.
Mechanic, D., Angel, R., & Davies, L. (1991). Risk and selection processes between the general and the specialty mental health sectors. Journal of Health and Social Behavior, 32, 49–64.
Moos, R. H., & Moos, B. S. (1998). The staff workplace and the quality and outcome of substance abuse treatment. Journal of Studies on Alcohol, 59, 43–51.
New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. (Final Report; DHHS Pub. No SMA-03-3832). Rockville, MD.
Pescosolido, B. A. (1992). Beyond rational choice: The social dynamics of how people seek help. American Journal of Sociology, 97, 1096–1138.
Pescosolido, B. A. (1996). Bringing the "Community" into utilization models. Research in the Sociology of Health Care, 13 A, 171–197.
Pescosolido, B. A., & Boyer, C. A. (1999). How do people come to use mental health services? Current knowledge and changing perspectives. In A. V. Horwitz, & T. L. Scheid (Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (pp. 392–411). New York: Cambridge University Press.
Pescosolido, B. A., Gardner, C. B., & Lubell, K. M. (1998). How people get into mental health services: Stories of choice, coercion and "muddling through" from "first-timers." Social Science and Medicine, 46(2), 275–286.
Phillips, K. A., Morrison, K. R., Andersen, R., & Aday, L. A. (1998). Understanding the context of healthcare utilization: Assessing environmental and provider-related variables in the behavioral model of utilization. Health Services Research, 33(3), 571–596.
Raiffa, H. (1968). Decision analysis: Introductory lectures on choices under uncertainty. Oxford: England Addison-Wesley.
Resnik, M. D. (1987). Choices: An introduction to decision theory. Minneapolis, MN: University of Minnesota Press.
Salzer, M. S., & Bickman, L. (1997). Delivering effective children's services in the community: Reconsidering the benefits of system interventions. Applied and Preventive Psychology, 6, 1–13.
Saunders, S., Resnick, M., Hoberman, H. M., & Blum, R. (1994). Formal help-seeking behavior of adolescents identifying themselves as having mental health problems. Journal of the American Academy of Child and Adolescent Psychiatry, 33(5), 718–728.
Schorr, L. B. (1997). Common purpose. New York: Doubleday.
Simon, H. A. (1990). Invariants of human behavior. Annual review of psychology, 41, 1–19.
Small, M. A. (1991). Obstacles and advocacy in children's mental health services: Managing the Medicaid maze. Behavioral Sciences and the Law, 9, 179–188.
Srebnik, D., Cauce, A. M., & Baydar, N. (1996). Helpseeking pathways for children and adolescents. Journal of Emotional and Behavioral Disorders, 4(4), 210–220.
Stiffman, A. R., Brown, E., Striley, C., Limb, G., Nelson, J., & Pescarino, R. (2002). Youths' treatment needs and access: contrasts in African American and American Indian experiences. Oral Presentation at Society of Social Work Research Conference, San Diego, CA.
Stiffman, A. R., Chen, Y. W., Elze, D., Dore, P., & Cheng, L. C. (1997). Adolescents' and providers' perspectives on the need for and use of mental health services. Journal of Adolescent Health, 21(5), 335–342.
Stiffman, A. R., Cheng, L. C., Chen, Y. W., & Dore, P. (1995, October 30-November 3). Social workers as gatekeepers of mental health services for teens. Paper presented at the annual meeting of the American Public Health Association, Washington, DC.
Stiffman, A.R., Dore, P., Cunningham, R. M., & Earls, F. (1995). Person and environment in HIV risk behavior change between adolescence and young adulthood. Health Education Quarterly, 22(2) 233–248.
Stiffman, A. R., Foster, K., Hamburg, K., & Dore, P. (2003). IMPROVE: A software program to improve assessments and multisector referrals. Oral presentation at the annual research conference of The Research and Training Center for Children's Mental Health, Tampa, FL.
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.
Stiffman, A. R., Striley, C. W., Brown, E., Limb, G., & Ostmann, E. (2003). American Indian youth: Southwestern urban and reservation youth's need for services and whom they turn to for help. Journal of Child and Family Studies, 12, 319–333.
Stiffman, A. R., Striley, C. W., Horvath, V., Hadley-Ives, E., Polgar, M., Elze, D., et al. (2001). Organizational context and provider perception as determinants of mental health service use. The Journal of Behavioral Health Services and Research, 28(2), 1–17.
Vanstraelen, M., & Cottrell, D. (1994). Child and adolescent mental health services: Purchasers' knowledge and plans. BMJ, 309, 259–261.
Wells, K. B., Golding, J. M., Hough, R. I. et al. (1998). Factors affecting the probability of youth of general and medical health and social/community services for Mexican Americans and non-Hispanic Whites. Medical Care, 26, 441–452.
Zahner, G. E. P., & Daskalakis, C. (1997). Factors associated with mental health, general health, and school-based service use for child psychopathology. American Journal of Public Health, 87(9), 1440–1448.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stiffman, A.R., Pescosolido, B. & Cabassa, L.J. Building a Model to Understand Youth Service Access: The Gateway Provider Model. Ment Health Serv Res 6, 189–198 (2004). https://doi.org/10.1023/B:MHSR.0000044745.09952.33
Issue Date:
DOI: https://doi.org/10.1023/B:MHSR.0000044745.09952.33