Recentering Preferences of Older Youth Exiting Foster Care to Understand Avenues for Mental Health Support

Background: Youth in the U.S. foster care system suffer from mental disorders at higher rates than the general population (Havlicek et al, 2013), and they are highly connected with treatments (therapy, medications) while in the system (McMillen et al, 2007). Rates of professional service use decline as young adults exit foster care, even though many continue to experience mental health problems (Lee et al, 2017). Prior work has identified alternative options for managing mental health that young adults may prefer including turning to friends and/or family, engaging spiritual advisors, or using substances. This study aimed to center youth preferences for different mental health help seeking options among a sample of youth aging out of foster care and explore the relationship between self-efficacy, behavioral beliefs, and social network factors with help seeking preferences.

Methods: A mixed-methods interviewer-administered survey was conducted with youth who were eligible to receive transition services for youth aging out in Texas (N=75). Items assessed demographics, current mental health status (PHQ-9 & GAD-7), and help-seeking preferences (Wilson et al, 2005). Predictors included self-efficacy and the advantages/disadvantages of each option using measures piloted in our prior work. Social network members were identified through a social network survey. Dichotomous variables were created for presence of types of network members which were used as predictors. Quantitative analyses included bi-variate analyses of each predictor with each help seeking option as a separate dependent variable. Thematic qualitative analysis was then used to contextualize and understand quantitative findings.

Results: Our sample was predominantly female (72%) and racially diverse (i.e. 40% Black, 25% Lantinx, 17% White). While half screened positive for a mental health problem, a majority of participants (61%) had received no treatment in the past year. Top help seeking preferences endorsed were intimate partners (n=56, 74.7%) and professionals (n=54, 72%), followed by friends (n=41, 54.7%) and family (n=38, 50.7%). While professionals were one of the top options endorsed in quantitative data, qualitative comments about mental health professionals were largely negative such as lack of trust and comfort with disclosing. Both self-efficacy and the perceived advantages scale of each treatment option was significantly associated with likelihood of using that option. For example, higher self-efficacy was associated with higher odds of seeking professional help (OR=6.0, p<.001) as was greater perceived advantages (OR=1.19, p=.011). Having an intimate partner or another supportive adult were each significantly associated with endorsing professional help seeking as a likely option (X² (1) = 11.21; p<.001) and (X² (1) = 14.33; p<.001, respectively).

Conclusion/Discussion: Findings highlight the importance of recognizing intimate partners as primary supports for managing mental health problems alongside the more commonly considered choice of engaging professional support. Natural supports were also associated with more positive preferences for professional help. Interventions to educate and support intimate partners and other natural supports may enhance mental health in a way that aligns with youth preferences. Finally, improving self-efficacy and identifying the advantages and disadvantages young adults associate with seeking help are points of intervention to increase professional help seeking when needed.