Advertisement

Mental Health Beliefs and Barriers to Accessing Mental Health Services in Youth Aging out of Foster Care

      Abstract

      Objective

      To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care.

      Methods

      Focus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the “threat of mental health problems,” treatment benefits versus barriers to accessing mental health services, self-efficacy, and “cues to action.” Data were analyzed using a modified grounded-theory approach.

      Results

      Youth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports “cueing action” during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation.

      Conclusions

      Youths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Adoption and Foster Care Analysis a Reporting System FY 2011 data (October 1, 2010–September 30, 2011). Available at: http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport19.pdf. Accessed July 3, 2013.

        • Havlicek J.
        • Garcia A.
        • Smith D.C.
        Mental health and substance use disorders among foster youth transitioning to adulthood: past research and future directions.
        Child Youth Serv Rev. 2013; 35: 194-203
        • Pecora P.J.
        • White C.R.
        • Jackson L.J.
        • Wiggins T.
        Mental health of current and former recipients of foster care: a review of recent studies in the USA.
        Child Fam Soc Work. 2009; 14: 132-146
        • McMillen J.C.
        • Zima B.T.
        • Scott L.D.
        • et al.
        Prevalence of psychiatric disorders among older youths in the foster care system.
        J Am Acad Child Adolesc Psychiatry. 2005; 44: 88-95
        • Pecora P.J.
        • Kessler R.C.
        • O’Brien K.
        • et al.
        Educational and employment outcomes of adults formerly placed in foster care: results from the Northwest Foster Care Alumni Study.
        Child Youth Serv Rev. 2006; 28: 1459-1481
        • McMillen J.C.
        • Scott L.D.
        • Zima B.T.
        • et al.
        Use of mental health services among older youths in foster care.
        Psychiatr Serv. 2004; 55: 811-817
        • McMillen J.C.
        • Raghavan R.
        Pediatric to adult mental health service use of young people leaving the foster care system.
        J Adol Health. 2009; 44: 7-13
        • Ringeisen H.
        • Casanueva C.E.
        • Urato M.
        • Strambaugh L.F.
        Mental health service use during the transition to adulthood for adolescents reported to the child welfare system.
        Psychiatr Serv. 2009; 60: 1084-1091
        • Fowler P.J.
        • Toro P.A.
        • Miles B.W.
        Emerging adulthood and leaving foster care: settings associated with mental health.
        Am J Community Psychol. 2011; 47: 335-348
        • Lopez P.
        • Allen P.J.
        Addressing the health needs of adolescents transitioning out of foster care.
        Pediatr Nurs. 2007; 33: 345-355
      2. The Patient Protection and Affordable Care Act of 2010, Public Law No. 111–148.

        • Singh S.P.
        • Paul M.
        • Ford T.
        • et al.
        Process, outcome and experience of transition from child to adult mental health care: multiperspective study.
        Brit J Psychiat. 2010; 197: 305-312
        • Hovish K.
        • Weaver T.
        • Islam Z.
        • et al.
        Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study.
        Psychiatr Rehabil J. 2012; 35: 251-257
        • Committee on Quality of Health Care in America, Institute of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academy Press, Washington, DC2001
        • Giacomini M.K.
        • Cook D.J.
        Users’ guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group.
        JAMA. 2000; 284: 478-482
        • Kitizinger J.
        Qualitative research: introducing focus groups.
        Br Med J. 1995; 311: 299-302
        • Rosenstock I.M.
        • Strecher V.J.
        • Becker M.H.
        Social learning theory and the health belief model.
        Health Educ Quart. 1988; 15: 175-183
        • Henshaw E.J.
        • Freedman-Doan C.R.
        Conceptualizing mental health care utilization using the health belief model.
        Clin Psychol (New York). 2009; 16: 420-439
        • Wilms D.G.
        • Best J.A.
        • Taylor D.W.
        • et al.
        A systematic approach for using qualitative methods in primary prevention research.
        Med Anthropol Q. 1990; 4: 391-409
        • Ryan G.W.
        • Bernard H.R.
        Techniques to identify themes.
        Field Methods. 2003; 15: 85-109
        • Iglehart J.K.
        The dilemma of Medicaid.
        New Engl J Med. 2003; 348: 2140-2148
        • Munson M.R.
        • Scott L.D.
        • Smalling S.E.
        • et al.
        Former system youth with mental health needs: routes to adult mental health care, insight, emotions, and mistrust.
        Child Youth Serv Rev. 2011; 33: 2261-2266
        • Samuel G.M.
        • Pryce J.M.
        “What doesn’t kill you makes you stronger”: survivalist self-reliance as resilience and risk among young adults aging out of foster care.
        Child Youth Serv Rev. 2008; 30: 1198-1210
        • Raghavan R.
        • Shi P.
        • Aarons G.A.
        • et al.
        Health insurance discontinuities among adolescents leaving foster care.
        J Adolesc Health. 2009; 44: 41-47
      3. The Chafee Foster Care Independence Act of 1999, Public Law No. 106–169.

      4. Pergamit MR, McDaniel M, Chen V, et al. ASPE Report: Providing Medicaid to Youth Formerly in Foster Care under the Chafee Option: Informing Implementation of the Affordable Care Act. November 2012. Available at: http://www.urban.org/publications/412786.html. Accessed October 23, 2013.

        • Council on Foster Care, Adoption, and Kinship Care and Committee on Early Childhood
        Health care of youth aging out of foster care.
        Pediatrics. 2012; 130: 1170-1173
        • Romanelli L.H.
        • Hoagwood K.E.
        • Kaplan S.J.
        • et al.
        Child welfare-mental health best practice group.
        Child Welfare. 2009; 88: 189-212
      5. Children’s Bureau. Making healthy choices: A guide on psychotropic medications for youth in foster care. Washington, DC; 2012. Available at: http://www.nrcyd.ou.edu/publication-db/documents/psychmedyouthguide.pdf. Accessed January 23, 2014.

        • Lee B.R.
        • Munson M.R.
        • Ware N.C.
        • et al.
        Experiences of and attitudes toward mental health services among older youths in foster care.
        Psychiatr Serv. 2006; 57: 487-492
      6. Leslie LK, Mackie TI, Dawson EH, et al. Multi-state study on psychotropic medication oversight in foster care. Tufts CTSI Study Report. September 2010. Available at: http://www.tuftsctsi.org/∼/media/Files/CTSI/Library%20Files/Psychotropic%20Medications%20Study%20Report.ashx.

        • Courtney M.E.
        • Piliavin I.
        • Grogan-Kaylor A.
        • Nesmith A.
        Foster youth transitions to adulthood: a longitudinal view of youth leaving care.
        Child Welfare. 2001; 80: 685-717
        • Kelly G.R.
        • Mamon J.A.
        • Scott J.E.
        Utility of the health belief model in examining medication compliance among psychiatric outpatients.
        Soc Sci Med. 1987; 25: 1205-1211