(PS5-C62) Clinical Impairment and Service Utilization in Youth: The Influence of Perceived Barriers on Treatment Engagement

Children and adolescents are increasingly suffering from emotional disorders, yet mental health services remain underutilized. Difficulty engaging families in mental health treatment is seen as a key underlying reason for the disparity between child mental health need and service use. Families seeking treatment often experience both tangible and intangible barriers, including practical obstacles such as time and cost, and poor attitudinal perceptions of treatment. Prior work has also shown that client factors including race, ethnicity, and socioeconomic status relate to the perception and experience of barriers to the treatment process. Further, the severity of a child’s emotional problems may influence how much effort is put into navigating barriers to treatment, with increased impairment motivating parents to access and utilize services for their youth. Therefore, this study sought to further understand links between sociodemographic characteristics, perceived barriers, and treatment engagement, while examining how clinical impairment moderates these relationships.

Participants include 196 families, with youth ages 12 to 18, recruited as part of a larger multi-site effectiveness trial. Parents completed self-report measures on sociodemographic information and perceived barriers to treatment participation (i.e., stressors and obstacles that compete with treatment, treatment demands and issues, and perceived irrelevance of treatment). Youth clinical impairment prior to treatment was determined via clinical interview with an independent evaluator. Youth treatment initiation, session attendance, and treatment termination status were collected as measures of treatment engagement. Hierarchal logistic modeling was used analyze the proposed relationships.

Results indicate that participants reported few perceived barriers on average. Perceived stressors and obstacles scores differed by parent education (F(7, 158) = 2.25, p = .03). Greater perceived stressors and obstacles predicted a lower number of treatment sessions attended (b = -1.87, t(66) = -2.21, p = .03) and a higher likelihood of premature termination (b = 0.99, t(46) = 2.07, p = .04). Black or African American families were less likely to initiate treatment than White families (b = 1.38, t(87) = 2.35, p = .02). Parents who completed an advanced degree had youth who attended more treatment sessions (b = 4.40, t(78) = 2.28, p = .03) and had a lower likelihood of premature termination (b = -1.24, t(62) = -2.26, p = .03), compared to parents with an education of high school/GED or lower. Youth of parents who were employed part time had a higher likelihood of initiating treatment (b = -1.59, t(85) = -2.43, p = .04) and attended more treatment session (b = 3.16, t(82) = 2.75, p = .007), compared to those whose parents were students or unemployed. Youth clinical impairment did moderate the relationship between perceived treatment demands and issues and treatment initiation (b = -0.07, t(63) = -2.13, p = .04), such that families were more likely to not initiate treatment at greater levels of perceived demands and issues if their child was more impaired (b = 0.63, t(63)= 2.33, p = 0.02). Future work will test more comprehensive models that examine both structural and perceived barriers.