This study examined the associations between social adversity, barriers-to-care (logistical obstacles, wait-time) and participation in children’s mental health treatment. The theoretical role of child symptoms (impact on the child, family burden) was addressed.
Records were obtained for 1,963 parents who had accessed community-based care for their child (3-17 years). Data were collected as part of a provincial (Ontario, Canada) screening and outcome measurement initiative. The data were analyzed using multivariate logistic regression.
Children with behavioural problems were at increased risk for attrition from treatment (OR=1.47, p < 0.001). The effect held upon controlling for age, gender, and co-morbid emotional symptoms; however, it was explained by child functional impairment. Similar effects were not found for the impact of symptoms on the family. Dropout was greater for adolescents (OR=1.43, p < 0.01) than younger children.
Disadvantaged youth were more likely to drop out than more advantaged clients (OR=1.86, p < 0.001). Perceptions of difficulties in attending treatment were associated with a decreased risk (OR=0.89, p < 0.001). The adversity and service relationships were not mediated by child behavioural symptoms, functioning, or family burden. Waiting for care did not influence parent decisions to participate.
Moderation analyses showed effects for adversity, service obstacles, emotional symptoms, functional impairment, and family burden for clients with behavioural problems. These children were more likely to drop out if they were socially disadvantaged, or had functional impairment at intake to services. However, completion was more likely for co-morbid children, and parental reports of burden. Families were also willing to overcome access difficulties in order to continue with treatment. There were few findings for children without behavioural problems.
The results suggest a focus on other constructs, such as parent cognitions, that may link adversity and barriers with participation. The effects for symptoms as a moderator, suggests different levels of service provision based on sub-types of children. Efforts to engage “high-risk” clients are necessary. On the other hand, resources for intensive services would be appropriate for clients with more severe problems.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:OTU.1807/32841 |
| Date | 31 August 2012 |
| Creators | Urajnik, Diana J. |
| Contributors | Ferguson, Bruce |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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