Barriers to Treatment Utilization and Attendance in a Multiple Family Group (MFG) Intervention Among Poverty-Impacted Families in New York

Background and Purpose: Urban children of color have the highest rates of Disruptive Behavior Disorders (DBD), yet are the least likely to access mental health treatment. Models of service use theorize that access is contingent upon individual and contextual/organizational factors, which are associated with providers and service settings. Because caregivers are typically responsible for initiating and continuing services for their children, individual factors, including health attitudes, perceived need for treatment, cost associated with services, and transportation needs, are very influential in treatment access for youth.  The current study aimed to examine the relationships between barriers to treatment utilization and attendance among poverty-impacted families in the New York metropolitan area.   

Methods: Data were obtained from a 4Rs and 2Ss Multiple Family Group (MFG) field-trial from 2006-2010 of caregivers of children between 7 and 11 years of age with a diagnosis of a DBD.  Participants of the experimental condition (n=225) were included in the current study and were recruited from 13 New York State Office of Mental Health-licensed public mental health clinics in New York.  Demographic characteristics were collected via a sociodemographic questionnaire, attendance in 4Rs and 2Ss groups was recorded weekly by facilitators, and barriers to treatment were measured using the Kazdin Barriers to Treatment (KBT) scale.  Data were analyzed using SPSS 24 and Mplus7, including univariate and bivariate analyses and Structural Equation Modeling (SEM).

Results: Caregiver competing activities and life stressor scores (t(171)= 3.23, p<.01) and critical events (t(171)= 2.21, p<.05) were independently significantly greater among participants who attended 7 sessions or less than participants who attended 8 sessions or more. The four most commonly experienced critical event was losing a job or having a change in income (13.3%), having a close friend or relative become ill or pass away during the time of treatment (10.7%), family size change (9.3%), and moving during the time of treatment (8%). For caregivers who endorsed moving too far away from the clinic, on average there was a 55% decrease in the likelihood of attending 8 or more sessions holding all other variables constant (b= -0.546, MOE= .414, p < .01). For caregivers who endorsed having a job change, on average there was a 42% decrease in the likelihood of attending 8 or more sessions holding all other variables constant (b= -0.419, MOE= .298, p < .01). Lastly, for caregivers who endorsed the child moved out of the home, on average there was a 34% increase in the likelihood of attending 8 or more sessions holding all other variables constant (b= 0.339, MOE= .310, p < .05).

Conclusions and Implications: Results highlight specific barriers to treatment utilization and the importance of clinicians focusing on issues of housing instability, transportation, employment seeking behavior, and caregiving needs within families.  Flexibility in appointments and consideration of alternate modalities (e.g. drop-in hours, open access, and tele therapy) have potential to increase utilization and allow for continuity of care when barriers emerge.  Future research is needed to evaluate barriers to treatment and alternate modalities in relation to service utilization.