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Parental Perceptions of Barriers to Care

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Parental Perceptions of Barriers to Care PARENTAL PERCEPTIONS OF BARRIERS TO CARE: AN EXAMINATION OF RURAL APPALACHIAN PARENTS’ EXPECTANCIES OF THE AVAILABILITY, PROCESS, AND OUTCOME OF MENTAL HEALTH SERVICES FOR ELEMENTARY SCHOOL-AGED CHILDREN A dissertation presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Caroline E. Murphy August 2005 This dissertation entitled PARENTAL PERCEPTIONS OF BARRIERS TO CARE: AN EXAMINATION OF RURAL APPALACHIAN PARENTS’ EXPECTANCIES OF THE AVAILABILITY, PROCESS, AND OUTCOME OF MENTAL HEALTH SERVICES FOR ELEMENTARY SCHOOL-AGED CHILDREN BY CAROLINE E. MURPHY has been approved for the Department of Psychology and the College of Arts and Sciences by Julie S. Owens Assistant Professor of Psychology Benjamin M. Ogles Interim Dean, College of Arts and Sciences MURPHY, CAROLINE E. Ph.D. August 2005. Clinical Psychology. Parental Perceptions of Barriers to Care: An Examination of Rural Appalachian Parents’ Expectancies of the Availability, Process, and Outcome of Mental Health Services for Elementary School-Aged Children (116 pp.) Director of Dissertation: Julie S. Owens The current study investigated parental perceptions of the availability of mental health services for elementary-aged children, as well as barriers to care including expectations of treatment process, relationship, and outcome. Parent data from two rural Appalachian Ohio areas were contrasted with that from an urban Ohio sample matched for SES so that beliefs across community types could be examined. Using anonymous questionnaire methodology, parents were surveyed about their perceptions of children’ mental health care in their respective communities. Parents provided responses to open- ended questions about what services are available in their community, and were then asked to rate the acceptability of these services. Further, they were provided with a checklist of various agencies or entities and were asked to denote those agencies that are available in their respective communities. Data were also gathered about parents’ preferred sources of referral for children’s mental health services, Appalachian heritage, and whether or not their child has ever received such services. Finally, parents responded to modified versions of the Barriers to Treatment Participation scale (Kazdin, Holland, & Breton, 1991) and the Expectations of Mental Health Care survey (Richardson, 2001). Results suggest that rural parents view community mental health centers as primary sources of mental health support for their children, whereas urban parents viewed medical institutions (e.g., pediatricians, hospitals) as their preferred source of such care. As anticipated, issues of relationship and trust with the therapist were particularly salient for individuals in the rural county areas of Appalachian Ohio, compared to those living in a rural city in the same region. This study presents one of the first examinations of children’s mental health care in rural areas, and is unique in its study of Appalachian regional effects. Findings from this study may serve to inform providers in underserved areas such as rural Appalachia how barriers including poverty and parent perceptions of mental health treatment may have differential effects in geographically isolated areas versus more metropolitan centers. Approved: Julie S. Owens Assistant Professor of Psychology Rural Children’s Mental Health 5 TABLE OF CONTENTS ABSTRACT....................................................................................................................3 LIST OF TABLES ..........................................................................................................7 INTRODUCTION...........................................................................................................8 Mental Health Services across Rural and Nonrural Areas ..............................................11 Definitional Issues .............................................................................................12 Perceptions of Need and Access.........................................................................13 Socioeconomic Status ........................................................................................16 Social Support....................................................................................................18 Health Care Coverage ........................................................................................19 Fragmentation in Systems of Mental Health Services Delivery...........................21 Appalachian Ohio..........................................................................................................26 Sociopolitical History.........................................................................................27 Appalachian Values ...........................................................................................28 Poverty in Appalachia........................................................................................29 Family Structure ................................................................................................30 Mental Health Service Utilization ......................................................................31 Barriers to Mental Health Care Services for Children ....................................................32 Parental Awareness of Mental Health Problems .................................................35 Insurance Coverage............................................................................................36 Parental Perceptions of Efficacy.........................................................................38 Parental Expectations of Therapeutic Relationship and Treatment Outcome.......39 The Present Study..........................................................................................................42 Predictions .........................................................................................................44 METHOD .....................................................................................................................47 Rural Children’s Mental Health 6 Participants ........................................................................................................47 Measures............................................................................................................52 Procedure...........................................................................................................57 Research Questions and Data Analytic Approach...............................................59 RESULTS .....................................................................................................................63 Actual Availability.............................................................................................63 Perceived Availability........................................................................................64 Barriers to Children’s Mental Health Care..........................................................73 Expectations of Children’s Mental Health Care..................................................74 DISCUSSION ...............................................................................................................76 Availability........................................................................................................77 Barriers to Care..................................................................................................79 Expectations of Mental Health Care ...................................................................80 Relationship with Therapist................................................................................80 Transformation of Mental Health Service Delivery ............................................82 Limitations.........................................................................................................87 Future Directions ...............................................................................................90 Conclusion.........................................................................................................92 REFERENCES..............................................................................................................93 APPENDICES.............................................................................................................106 Appendix A—Parent Questionnaire .................................................................107 Appendix B—Parent Recruitment Flyer...........................................................112 Appendix C—April 2005 Ohio Unemployment Rates......................................114 Appendix D—Map of Appalachian Ohio .........................................................115 Appendix E—Parents’ Acceptability Ratings of Mental Health Agenices.........116 Rural Children’s Mental Health 7 LIST OF TABLES Table 1: Sample Demographic Characteristics by Community Type..............................49 Table 2: Socioeconomic Status (Hollingshead, 1975) of Respondents by Community Type ..................................................................................................................51 Table 3: Agencies Listed First in Free-Response Perceived Availability by Community Type ..................................................................................................................65 Table 4: Agencies Listed Second in Free-Response Perceived Availability by Community Type
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