Parental Perspective on Factors Influencing Children's Mental Health Service Utilization in Rural Communities

Background and Purpose:

This mixed-methods study examines factors influencing rural children's mental health service use from parents' perspectives. Rural children experience higher rates of anxiety (89.6% vs. 83.8%), behavioral problems (18.1% vs. 11.5%), and depression (79.9% vs. 77.2%) than urban peers but have fewer services. Nationally, one in seven children have a diagnosed mental health condition, and only half receive needed care. The persistent gap between mental health needs and service availability in rural settings is a critical public health concern. Although national and state data highlight service gaps, little is known about how structural and individual factors shape parents' decisions in these communities. This limits the development of targeted interventions and policy solutions. Using Andersen and Newman's Behavioral Health Model, the study investigates how predisposing factors (demographics), enabling resources (income, insurance), and need factors (perceived necessity) predict service use. Findings aim to inform efforts to reduce barriers and expand access.

Method:

This study used a sequential explanatory mixed-methods design to examine factors predicting mental health service utilization in rural communities. The quantitative phase analyzed secondary data from the 2022 National Survey of Children's Health (NSCH) (N = 152) using forward logistic regression to assess how predisposing (demographics), enabling (income, insurance), and need factors (mental health status) predicted service utilization. The qualitative phase involved six semi-structured interviews exploring the lived experiences and decision-making related to children's mental health service use. Findings were integrated through a joint display, aligning statistical results with qualitative themes.

Results:

The mixed-methods analysis produced divergent findings across quantitative and qualitative strands. Quantitative results showed no statistically significant association between predisposing, enabling, and need factors and children’s mental health service use, diverging from previous studies emphasizing structural barriers. To explore this discrepancy, qualitative interviews with six rural parents revealed four central themes. First, financial and insurance constraints compelled families to make deliberate sacrifices, including out-of-pocket payments, credit card use, or forgoing non-essential expenses. Second, provider shortages and geographic isolation required travel of 30–45 minutes to access care. Third, service-seeking was often prompted by professional identification of mental health needs, with scheduling conflicts and work demands further complicating access. Fourth, parents prioritized therapeutic effectiveness and relational fit over demographic similarity. Integrated findings suggest that while quantitative models may not capture significant structural predictors, qualitative data illuminate the lived complexity of access barriers and parental decision-making in rural contexts, demonstrating the value of mixed-methods approaches to understanding service utilization.

Conclusion:

This study reveals a disconnect between quantitative predictors of service use and the lived experiences of rural families seeking mental health care for children. The absence of significant statistical relationships challenges current models and points to the need for frameworks that reflect rural realities. Qualitative insights highlight how financial strain, provider shortages, and professional gatekeeping influence parental decisions. Implications for social work practice include addressing structural and perceptual barriers to care. Future research should refine existing models and include more diverse rural samples. Policy recommendations involve expanding Medicaid participation, strengthening service infrastructure, and promoting early identification.