Parent and Adolescent Concordance On Perceived Need for Mental Health Services and Its Impact On Service Use

Background and Purpose: Unmet mental health need among African American adolescents remains a significant public health issue. Untreated mental health problems (i.e., depression) lead to high rates of school dropout, sexual risk behaviors, and suicide among African American adolescents. Given the adverse outcomes of depression and multiple stressors associated with residing in high-risk environments, we sought to examine potential factors related to unmet mental health need. Research indicates that family-level factors (low family support, caregiver mental health need) play a significant role in the underutilization of services among African American adolescents. Yet, little is known about the relationship between parent-adolescent concordance (agreement) on perceived need for services and actual service use, thus the primary objective of this study. Research questions were: 1. Do parents and adolescents agree on the need for services? 2. Is there an association between agreement on perceived need and depression severity? 3. Are there significant differences in the average number of appointments kept between concordant and discordant parent-adolescent dyads in perceived need?

Methods: This exploratory, prospective study recruited parent-adolescent dyads (n=108) from a child/adolescent community mental health agency in a metropolitan, Midwestern city. The participants were mostly African American (n=102), followed by other ethnic minorities (2 bi-racial, 2 Latino, and 2 American Indian). Ages ranged from 12-17 and grade level ranged from 5th-12th grade. Approximately 54% of the adolescent sample was female. Common diagnoses were ADHD (51.4%) and mood disorder (35.8%). Researchers contacted families via mail, introducing the project in a packet sent by the mental health agency. During the intake session, agency staff explained the study to eligible participants (adolescents ages 12-17 and one parent/guardian referred for outpatient mental health services) and invited parents and adolescents to participate. Clients completed a depression-screening tool and brief interview between April 2008 - March 2009. The RADS-2 measured depression severity (clinical cutoff of >76) and perceived need was measured by questions asking parents and adolescents if a counselor (individual, group, family therapy) and psychiatrist (evaluation, medical review) were needed in the past 6 months (options were yes or no). Similar parent and adolescent responses indicated concordance. Service use was defined as the number of appointments kept divided by the number of appointments scheduled (data collected from May 2008-June 2009). We assessed the average rates of service use based on concordant/discordant dyads. Data analyses included McNemar's Test, Chi-Square, and ANOVA.

Results: Findings revealed a significant difference in the proportion of parents and adolescents reporting a perceived need for a counselor, indicating low concordance. Significantly lower rates of parent-adolescence concordance were found among youth reporting elevated depression symptoms compared to youth reporting normal range symptoms. Concordant dyads, on average, kept a higher number of appointments than discordant dyads (although, non-significant).

Conclusions/Implications: Parents and adolescents, especially those most in need, are in disagreement on the need for services. This may negatively affect families' decision to seek and use services. Providers should facilitate parent-adolescent concordance at the onset of treatment seeking. Authors discuss implications for social work practice and future research.