Advertisement

Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers

Abstract

Systems of care (SOCs) have the potential to enhance underserved families’ access to integrated health and support services. Most scholarship on SOCs has involved school-aged children and adolescents. Thus, research is needed to better understand barriers to, and facilitators of, families’ access to services during early childhood. The present study included a community-based participatory approach in understanding services for families of children under age six years with severe emotional and behavioral problems. We analyzed data from two focus groups with caregivers (n = 7) and three focus groups with service providers (n = 22). Our thematic analysis of participants’ responses revealed five primary barriers to family service access, including challenges associated with transition planning. In comparison, participants described four primary facilitators of family service access, including providers’ adoption of “whole-family” service delivery approaches. Findings indicated areas of convergence and divergence in caregivers’ and providers’ responses. We discuss limitations and potential implications.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

References

  1. Andersen, R. M., Davidson, P. L., & Baumeister, S. E. (2014). Improving access to care. In G. F. Kominski (Ed.), Changing the U.S. health care system: Key issues in health services policy and management. Hoboken, NJ: Wiley.

  2. Anderson, J. K., Howarth, E., Vainre, M., Jones, P. B., & Humprehy, A. (2017). A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people. Children and Youth Services Review, 77, 164–176.

  3. Atkins, M. S., Frazier, S. L., Birman, D., Adil, J. A., Jackson, M., Graczyk, P. A.,…, McKay, M. M. (2006). School-based mental health services for children living in high poverty urban communities. Administration and Policy in Mental Health and Mental Health Services Research, 33, 146–159.

  4. Atkins, M. S., Rusch, D., Mehta, T. G., & Lakind, D. (2016). Future directions for dissemination and implementation science: Aligning ecological theory and public health to close the research to practice gap. Journal of Clinical Child & Adolescent Psychology, 45(2), 215–226.

  5. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial-ethnic disparities in health and health care. Public Health Reports, 118, 293–302.

  6. Boydell, K. M., Pong, R., Volpe, T., Tilleczek, K., Wilson, E., & Lemieux, S. (2006). Family perspectives on pathways to mental health care for children and youth in rural communities. The Journal of Rural Health, 22(2), 182–188.

  7. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

  8. Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America’s disadvantaged children. Children and Youth Services Review, 32(10), 1291–1299.

  9. Bronfenbrenner, U. (1979). Ecology of human development. Cambridge, MA: Harvard University Press.

  10. Campbell, F., Conti, G., Heckman, J. J., Moon, S. H., Pinto, R., Pungello, E., et al. (2014). Early childhood investments substantially boost adult health. Science, 343(6178), 1478–1485.

  11. Case, A. D., Byrd, R., Claggett, E., Deveaux, S., Perkins, R., Huang, C., et al. (2014). Stakeholders’ perspectives on community-based participatory research to enhance mental health services. American Journal of Community Psychology, 54(3–4), 397–408.

  12. Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration. (2007). National evaluation data manual.

  13. Chamberlain, J. (2005). User/consumer involvement in mental health service delivery. Epidemiologia e Psichiatria Sociale, 14(1), 10–14.

  14. Champine, R. B., Whitson, M. L., & Kaufman, J. S. (2018). Service characteristics and family involvement in an early childhood system of care. Journal of Child and Family Studies, 27(1), 324–338.

  15. Chapman, M. V., Gibbons, C. B., Barth, R. P., & McCrae, J. S. (2003). Parental views of in-home services: What predicts satisfaction with child welfare workers? Child Welfare, 82(5), 571–596.

  16. Charles, J. L. K., & Bentley, K. J. (2018). Measuring mental health provider-based stigma: Development and initial psychometric testing of a self-assessment instrument. Community Mental Health Journal, 54(1), 33–48.

  17. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N.,…, Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 11–27.

  18. Cochran, P. A., Marshall, C. A., Garcia-Downing, C., Kendall, E., Cook, D., McCubbin, L., et al. (2008). Indigenous ways of knowing: Implications for participatory research and community. American Journal of Public Health, 98(1), 22–27.

  19. Crawford, M. J., Rutter, D., Manley, C., Weaver, T., Bhui, K., Fulop, N., et al. (2002). Systematic review of involving patients in the planning and development of health care. British Medical Journal, 325, 1–5.

  20. Glenton, C., Colvin, C., Carlsen, B., Swartz, A., Lewin, S., Noyes, J., et al. (2013). Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: Qualitative evidence synthesis. Cochrane Database Systematic Review, 2013(2), CD010414. https://doi.org/10.1002/14651858.cd010414.

  21. Gondek, D., Edbrooke-Childs, J., Velikonja, T., Chapman, L., Saunders, F., Hayes, D., et al. (2016). Facilitators and barriers to person-centred care in child and young people mental health services: A systematic review. Clinical Psychology & Psychotherapy, 1, 4. https://doi.org/10.1002/cpp.2052.

  22. Greenwood, N., Habibi, R., Smith, R., & Manthorpe, J. (2015). Barriers to access and minority ethnic carers’ satisfaction with social care services in the community: A systematic review of qualitative and quantitative literature. Health and Social Care in the Community, 23(1), 64–78.

  23. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113. https://doi.org/10.1186/1471-244x-10-113.

  24. Hancock, N., Bundy, A., Tamsett, S., & McMahon, M. (2012). Participation of mental health consumers in research: Training addressed and reliability assessed. Australian Occupational Therapy Journal, 59(3), 218–224.

  25. Heaman, M. I., Sword, W., Elliott, L., Moffatt, M., Helewa, M. E., Morris, H.,…, Cook, C. (2015). Barriers and facilitators related to the use of prenatal care by inner-city women: Perceptions of health care providers. BMC Pregnancy and Childbirth, 15, 1–13.

  26. Heflinger, C. A., & Hinshaw, S. P. (2010). Stigma in child and adolescent mental health services research: Understanding professional and institutional stigmatization of youth with mental health problems and their families. Administration and Policy In Mental Health, 37(1–2), 61–70.

  27. Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013). Mental illness stigma, help seeking, and public health programs. American Journal of Public Health, 103(5), 777–780.

  28. Hernandez, M., & Hodges, S. (2003). Building upon the theory of change for systems of care. Journal of Emotional and Behavioral Disorders, 11(1), 19–26.

  29. Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. L. (2017). Improving mental health access for low-income children and families in the primary care setting. Pediatrics. https://doi.org/10.1542/peds.2015-1175.

  30. Hooper, L. M., Huffman, L. E., Higginbotham, J. C., Mugoya, G. C. T., Smith, A. K., & Dumas, T. N. (2018). Associations among depressive symptoms, wellness, patient involvement, provider cultural competency, and treatment nonadherence: A pilot study among community patients seen at a university medical center. Community Mental Health Journal, 54, 138–148.

  31. Horwitz, S. M., Gary, L. C., Briggs-Gowan, M. J., & Carter, A. S. (2003). Do needs drive services use in young children? Pediatrics, 112(6), 1373–1378.

  32. Hulme, J., Dunn, S., Guilbert, E., Soon, J., & Norman, W. (2015). Barriers and facilitators to family planning access in Canada. Healthcare Policy, 10(3), 48–63.

  33. Kaufman, J. S., Crusto, C. A., Quan, M., Ross, E., Friedman, S. R., O’Reilly, K., & Call, S. (2006). Utilizing program evaluation as a strategy to promote community change: Evaluation of a comprehensive, community-based, family violence initiative. American Journal of Community Psychology, 38(3–4), 191–200.

  34. Kaufmann, R. K., & Hepburn, K. S. (2007). Early childhood mental health services and supports through a systems approach. In D. F. Perry, R. K. Kaufmann, & J. Knitzer (Eds.), Social and emotional health in early childhood: Building bridges between services and systems (pp. 63–96). Baltimore, MD: Paul H. Brookes Publishing.

  35. Knutson, K. H., Meyer, M. J., Thakrar, N., & Stein, B. D. (2017). Care coordination for youth with mental health disorders in primary care. Clinical Pediatrics, 57(1), 5–10.

  36. Koerting, J., Smith, E., Knowles, M. M., Latter, S., Elsey, H., McCann, D. C.,…, Sonuga-Barke, E. J. (2013). Barriers to, and facilitators of, parenting programmes for childhood behaviour problems: A qualitative synthesis of studies of parents’ and professionals’ perceptions. European Child and Adolescent Psychiatry, 22(11), 653–670.

  37. Krueger, R. A., & King, J. A. (1998). Involving community members in focus groups (Focus Group Kit, Volume 5). Thousand Oaks, CA: Sage Publications. https://doi.org/10.4135/9781483328140.

  38. Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 1–9.

  39. Maneze, D., DiGiacomo, M., Salamonson, Y., Descallar, J., & Davidson, P. M. (2015). Facilitators and barriers to health-seeking behaviours among Filipino migrants: Inductive analysis to inform health promotion. BioMed Research International, 2015, 1–9.

  40. McCormack, L., Thomas, V., Lewis, M. A., & Rudd, R. (2017). Improving low health literacy and patient engagement: A social ecological approach. Patient Education and Counseling, 100(1), 8–13.

  41. Morris, A. S., Robinson, L. R., Hays-Grudo, J., Claussen, A. H., Hartwig, S. A., & Treat, A. E. (2017). Targeting parenting in early childhood: A public health approach to improve outcomes for children living in poverty. Child Development, 88(2), 388–397.

  42. Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41(6), 731–738.

  43. Pescosolido, B. A., Perry, B. L., Martin, J. K., McLeod, J. D., & Jensen, P. S. (2007). Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services, 58(5), 613–618.

  44. Pope, C., van Royen, P., & Baker, R. (2002). Qualitative methods in research on healthcare quality. BMJ Quality & Safety, 11(2), 148–152.

  45. Pullmann, M. D. (2009). Participatory research in systems of care for children’s mental health. American Journal of Community Psychology, 44(1–2), 43–53.

  46. Pullmann, M. D., VanHooser, S., Hoffman, C., & Heflinger, C. A. (2010). Barriers to and supports of family participation in a rural system of care for children with serious emotional problems. Community Mental Health Journal, 46(3), 211–220.

  47. Pumariega, A. J., Rogers, K., & Rothe, E. (2005). Culturally competent systems of care for children’s mental health: Advances and challenges. Community Mental Health Journal, 41(5), 539–555.

  48. Sloper, P. (2004). Facilitators and barriers for coordinated multi-agency services. Child: Care, Health, and Development, 30(6), 571–580.

  49. Stroul, B. A., Blau, G. M., & Friedman, R. M. (2010). Updating the system of care concept and philosophy. National Technical Assistance Center for Children’s Mental Health, Georgetown University Center for Child and Human Development. Retrieved from https://gucchdtacenter.georgetown.edu/resources/Call%20Docs/2010Calls/SOC_Brief2010.pdf.

  50. Tebes, J. K., Bowler, S. M., Shah, S., Connell, C. M., Ross, E., Simmons, R.,…, Kaufman, J. S. (2005). Service access and service system development in a children’s behavioral health system of care. Evaluation and Program Planning, 28(2), 151–160.

  51. Whitson, M. L., & Connell, C. M. (2016). The relation of exposure to traumatic events and longitudinal mental health outcomes for children enrolled in systems of care: Results from a national system of care evaluation. American Journal of Community Psychology, 57(3–4), 380–390.

  52. Whitson, M. L., Connell, C. M., Bernard, S., & Kaufman, J. S. (2011). The impact of youth and family risk factors on service recommendations and delivery in a school-based system of care. The Journal of Behavioral Health Services & Research, 38(2), 146–158.

  53. Whitson, M. L., Kaufman, J. S., & Bernard, S. (2009). Systems of care and the prevention of mental health problems for children and their families: Integrating counseling psychology and public health perspectives. Prevention in Counseling Psychology, 3(1), 3–9.

  54. Williams, M. E., Perrigo, J. L., Banda, T. Y., Matic, T., & Goldfarb, F. D. (2013). Barriers to accessing services for young children. Journal of Early Intervention, 35(1), 61–74.

Download references

Acknowledgements

The preparation of this paper was supported, in part, by the first author’s National Institutes of Health T32-funded postdoctoral training fellowship (T32DA019426-11) and with additional support from a cooperative agreement provided to the State of Connecticut by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

Author information

Correspondence to Robey B. Champine.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Champine, R.B., Shaker, A.H., Tsitaridis, K.A. et al. Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers. Community Ment Health J 55, 942–953 (2019) doi:10.1007/s10597-019-00418-4

Download citation

Keywords

  • System of care
  • Early childhood
  • Service access
  • Qualitative analysis