The Role of Parents In Facilitating Mental Health Treatment for Their Adolescents

Background and Purpose: The belief of a female parent/guardian that a youth needs mental health services is the most significant factor associated with service use (Horwitz, et al., 1992). Far fewer youth who might benefit from treatment actually receive it (Costello et al., 1993), and this is exacerbated by socio-economic and race/ethnicity factors (Turpin, et al., 1980). Thus, a better understanding of how parents facilitate their youths' treatment can help reduce unmet need and the resulting disparity in mental health treatment for children and adolescents. In addition, research on adolescent psychopathology and on the effectiveness of psychopharmacology is complemented by studies aimed at clarifying parents' role in the help-seeking process. Thus, this qualitative study investigated how parents enacted their parental responsibilities in addressing their adolescents' mental distress.

Methods: A non-random, exploratory secondary analysis was undertaken to examine the subjective experience of parents of mentally distressed youth (ages 12-17). The study utilized transcripts of forty-three parents who had participated in an NIMH study designed to examine parents' experiences with adolescents' emotional illness and treatment. Respondents who resided in a mid-west urban center were predominately female (95%) and reflected diversity in terms of race/ethnicity, age, socio-economic status, education, and in the adolescents' primary diagnoses. A thematic analysis was conducted wherein Atlas.ti software was used to “in vivo” code respondents' descriptions of their assessment, initiation, and maintenance of their youths' treatment process. Using the constant comparative method, the themes were grouped under higher level constructs, which then represented parents' role in facilitating treatment.

Results: The following ten strategies of how parents reported enacting their responsibilities toward their youths' emotional distress were found: 1) Seeking out information; 2) Acknowledging own & family members' illness/treatment; 3) Seeking family and social support; 4) Dealing with conflict; 5) Seeking and accepting professional help; 6) Communicating; 7) Navigating the unknown and second guessing; 8) Advocating; 9) Monitoring; and, 10) Gaining understanding. The findings also suggested that the unique social context of each parent/youth dyad influenced which subset of activities was deployed by a given parent. For example, a parent who had not successfully dealt with internal conflict associated with guilt made minimal use of strategies related to monitoring and seeking information.

Conclusions and Implications: Each of the ten strategies can be represented on a continuum. For instance, the activity of “seeking family and social support” contains “reaching out to others” at one end of the continuum and “avoiding others” at the other end. Clinicians can use this list of strategies as an informal assessment tool. Doing so, can help clinicians gain a better understanding of how a given parent's actions or inactions, may be contributing to a help-seeking process whose overall impact is either more proactive in nature (i.e., facilitating resolution of the youth's problems) or more reactive in nature (i.e., impeding resolution of the youth's problems). Moreover, if mental health providers and systems incorporate an understanding of how social context affects parental initiation and maintenance of services, such efforts could contribute to reducing service use disparities.