Research That Matters (January 17 - 20, 2008)

Purpose: Epidemiological studies have found a large gap between mental health need and actually obtaining services by children and adolescents. According to the 2001 Surgeon General's Report on children's mental health, 20% of children needed mental health care but only a small percentage of these children were receiving appropriate care. These statistics are particularly disconcerting when expansions of federal programs such as systems of care were initiated to improve access and services to children. The question then remains about barriers to children and adolescents accessing services, especially continued services. Basing the conceptual framework on the Help-seeking Decision-Making model and extending it to include outcomes in help seeking (i.e., continued or stopped), the present study addresses the following: • What individual and environmental factors influence youth's mental health utilization? • Given their entry into care, what service settings were utilized? Methods: Data from Wave I and Wave II of the National Longitudinal Study of Adolescent Health (Add Health) were used for these analyses. These data came from a national representative sample of youth from the U.S. Youth participated in several surveys; however, the present study relied primarily on information from the youth's in-home questionnaires and the contextual database. Although two waves of data were used for the study, the analysis was cross-sectional. The only information derived from Wave II data was whether or not a youth obtained mental health services. This was done to establish the category of continued care (i.e., youth obtained care in both Wave I and Wave II). After merging databases and constructing the necessary variables, the final analytical sample was 13,568. Both bivariate and multivariate analyses were conducted on weighted data using STATA 8.1. Results: Approximately 7% of youth obtained care at least once at Wave I and about 4.5% of youth obtained care both at Wave I and Wave II. Youth who continued care primarily sought this care in a private doctor's office although the school setting was the initial entry. Results from the multivariate logistic regressions examining one time care, continued care, and service setting showed that several individual and environmental level factors (i.e., parent characteristics, race/ethnicity, gender, and provider availability) were associated with mental health utilization. African-American youth living in urban or poor areas were less likely to obtain continued care. Additionally, African-American, Hispanic, and poor youths were more likely to obtain care at school than other care settings. Implications: There is a clear racial and ethnic disparity in utilization of mental health services, especially for continued care. African-American youth are not only obtaining care less frequently, they are also more likely to obtain care in a non-specialty environment such as schools. A reliance on schools as a place of mental health care has implications for school social workers who often deliver services in school-based mental health clinics as well as policy-makers who decide on funding for school based mental health services.