African American families of youth with Attention-deficit/hyperactivity disorder (ADHD) traditionally have lower rates of ADHD treatment compared to nonminority groups. These treatment disparities underscore the importance of better understanding the barriers to treatment for these families. Therefore, in a sample of 67 African American caregivers of children with ADHD, the current study examined (1) factors that predict barriers to treatment for African American families of children with ADHD and (2) whether caregiver impairment mediates comorbid behavior problems and barriers to treatment for African American youth with ADHD. Analyses revealed that caregiver impairment predicted barriers to treatment and mediated the relationship between comorbid behavior problems and barriers to treatment. These findings highlight how caregiver impairment may play a significant role in preventing African American families from engaging in ADHD treatment for their child. Furthermore, targeting caregiver impairment in treatment may be particularly beneficial for African American families of youth with ADHD.

An efficacious treatment is diminished in value if clients will not seek it out and adhere to it (Kazdin, 1978). Thus, the acceptability of a treatment to consumers is an important indicator of the quality/effectiveness of the treatment (APA, 2002). The purpose of this study was to examine acceptability of treatments for depression to adolescent females and to explore factors that might be associated with acceptability. Sixty-seven high school students (36 Hispanic and 31 non-Hispanic White) were recruited from communities in New Jersey and Florida, and interviewed by telephone. Participants were presented with a vignette describing a depressed adolescent and asked to use the Abbreviated Acceptability Rating Profile to indicate their opinion of four single treatments (cognitive-behavioral therapy, interpersonal therapy, family therapy, and pharmacotherapy) for depression and three treatment combinations. Consistent with hypotheses, psychotherapy approaches were generally more acceptable to adolescents than combinations of psychotherapy and pharmacotherapy. Pharmacotherapy used alone was not acceptable, on average. There was preliminary evidence to support the hypotheses that treatment acceptability is related to ethnicity, acculturation, and perceived causes of depression; however, contrary to expectations, treatment acceptability was not associated with symptom severity in this study. Implications for increasing the utilization of mental health services in this population are discussed and directions for future research are offered.

Doctor of Philosophy / Department of Special Education, Counseling and Student Affairs / Kakali Bhattacharya / Doris W. Carroll / This qualitative case study is designed to explore how two participants described their role with their use of counselor self-disclosure in establishing and maintaining therapeutic alliance with military clients. Utilizing purposeful and criterion-based sampling, participants for this study were counselors who worked with the military populations, had independent practices, and believed that counselor self-disclosure was beneficial in building strong therapeutic alliances with military clients. Informed by Symbolic Interactionism, the participants’ understanding of self-disclosure and its role in establishing and maintaining therapeutic alliance with military clients were explored through semi-structured, in-depth, open-ended interviews. Counselor self-disclosure (CSD) is a technique that helps to establish strong therapeutic alliances and break down barriers that may exist between the military population and their counselors. Some military members experience mental health disorders following deployments. However, these military members experience barriers when seeking treatment and they commonly terminate treatment prematurely. Findings indicate that when counselors use self-disclosure it inspires participants to open up and model their counselor’s behavior. Moreover, military clients become aware of their own symptoms that were previously invisible to them, and find ways to relate and trust the counselor. Conversely, findings also indicate that CSD can be used improperly or even when used properly could have undesired effects such as causing ruptures in the therapeutic relationship due to a lack of clients’ openness, or perceiving CSD unprofessional and an inauthentic way to elicit therapeutic alliance. This study has implications for counselor educators and practitioners to consider training about relationally-oriented cultural practices that help to prevent ruptures in therapeutic alliances with military clients. Another implication is about how CSD could be used in the preparation of students in counselor education training programs and how more inquiry could be conducted to document systematic data about the influence of CSD on therapeutic alliance. Finally, the study has implications about how CSD can facilitate support for military clients and critically understanding how CSD can aid in supporting retention or loss of treatment for military clients.

Migration is on the rise as Haitians seek economic and educational opportunities for their progeny in the U.S. Though migration to a new country often introduces a new set of immigration and acculturation-related stressors that can lead to mental health problems, Haitians remain underrepresented in clinical mental health settings. Previous studies with ethnic minority populations have enumerated several barriers to seeking mental health services. However, research on barriers to help-seeking is sorely lacking for specific migrant groups, including Haitians. Thus, this study examined barriers to seeking help for mental health problems among Haitians. Participants were recruited using purposive and snowball sampling methods. Specifically, recruitment flyers were used to recruit participants meeting specific inclusion criteria, and these participants identified other participants who qualified for this study. Data were collected via four focus groups from 26 Haitian adults, ranging from 18 to 52 years old. A semi-structured focus group protocol developed from research literature was used to conduct these focus groups. Qualitative data analysis was used to organize focus group data into themes. Three major themes emerged: (a) beliefs related to seeking mental health services, (b) cultural values and help-seeking, and (c) education and awareness of services and help-seeking. More specifically, participants noted that Haitian’s beliefs (e.g., religious/spiritual beliefs and beliefs about therapy, therapists, social consequences, and trustworthiness of institutions), cultural values (e.g., minimization of mental health problems, accepting problems as part of life), and education and awareness of mental health and mental health services contribute to Haitians’ likelihood to seek services. In addition, participants noted that these factors likely vary for first and second generation Haitian Americans, which further influences likelihood to seek services. These results suggest that both Haitians (first and second generation) and mental health professionals must take an active role to address barriers to help-seeking related to Haitians’ beliefs, cultural values, and education and awareness of mental health services, and subsequently, enhance treatment engagement.

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Masters of Art / High rates of substance use and its associated problems afflict Cape Town, underscoring the need for easily accessible substance abuse treatment. Despite the substantial benefits for both individuals and society at large that substance abuse treatment confers, substance abusers often first have to negotiate considerable challenges in order to access treatment and accumulate these gains. That is, experiencing barriers to accessing treatment, together with the presence of socio-demographic features, rather than “need for treatment”, decides who accesses treatment. Referrals are the gateway to inpatient substance abuse treatment in the Western Cape. While several barriers to accessing treatment have been identified by prior studies, none examine these phenomena from the point of view of the agents responsible for referring substance users for treatment. Moreover, access barriers to inpatient substance abuse services are a neglected area in extant literature. To address this gap, this study explored the perceptions of referring agents‟ of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape. This enabled the researcher to compare existing access barriers to treatment as identified by prior research, to those elucidated in the study. Bronfenbrenner‟s Process-Person-Context-Time model was employed as the basis for understanding identified barriers. In accordance with the exploratory qualitative methodological framework of the study, six semi-structured individual in-depth interviews were conducted with referring agents‟ of differing professional titles who were purposefully selected and expressed a willingness to participate in the study. Interviews were audio-recorded, and transcripts were analysed and interpreted by means of Thematic Analysis. Two broad thematic categories of access barriers were identified: Person-related barriers (denial, motivation for treatment, gender considerations, disability, active TB disease, homelessness, psychiatric co-morbidity) and Context-related barriers to treatment (cultural and linguistic barriers, stigma, community beliefs about addiction and treatment, awareness of substance abuse treatment, affordability/ financial barriers, geographic locations of treatment facilities, waiting time, lack of collaboration within the treatment system, beliefs of service providers‟, lack of facilities/ resources within the treatment system, practices at inpatient facilities, referral protocol and uninformed staff). Results suggest that by targeting the aforementioned barriers, access to inpatient and outpatient treatment services can be improved, and recommendations for interventions are offered in this regard. Ethical principles such as obtaining informed consent and ensuring confidentiality were abided by throughout the study and thereafter.

Unique barriers prevent parents in rural areas from seeking mental health services for their children. The implementation of innovative models of service delivery may reduce these barriers' impact on rural parents' treatment seeking. The purpose of this study was to determine: 1) parents' willingness to use innovative service delivery models; 2) barriers that parents perceive to seeking treatment in each of the 4 service delivery models, and; 3) the relationship between perceived barriers and willingness to seek help in the context of 4 service delivery models. Surveys were distributed to parents of children attending school in several counties in rural Appalachia. Results showed that parents perceived different barriers for different service models and that perceived barriers affected willingness differently depending on the model asked about. These results suggest that the use of innovative models (e.g., telehealth) may be acceptable in rural areas as alternatives to traditional mental health services.

No description available.