Sakai Christina, Mackie Thomas I, Shetgiri Rashmi, Franzen Sara, Partap Anu, Flores Glenn, Leslie Laurel K
Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Mass.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass.
Acad Pediatr. 2014 Nov-Dec;14(6):565-73. doi: 10.1016/j.acap.2014.07.003. Epub 2014 Oct 30.
To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care.
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.
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.
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.
探讨青少年对脱离寄养照顾后影响心理健康服务利用因素的看法。
对有心理健康需求历史且曾使用过服务的脱离寄养照顾的青少年进行焦点小组访谈。问题基于健康信念模型提出，涵盖4个领域：青少年对“心理健康问题威胁”的认知、心理健康服务的治疗益处与获取障碍、自我效能感以及“行动线索”。采用改良的扎根理论方法对数据进行分析。
28名青少年报告存在影响其功能的持续心理健康问题；然而，他们阐述了在依赖正规心理健康治疗与依靠自身能力在不接受治疗的情况下解决这些问题方面的不同程度。过去的心理健康服务经历影响青少年是否认为治疗选择有益。青少年在脱离寄养照顾过渡期间，自我效能感有限，心理社会支持不足（“行动线索”不足）。获取心理健康服务的障碍包括难以获得医疗保险、找到心理健康服务提供者、安排预约以及交通问题。
青少年对自身心理健康需求的认知、自我效能感、过渡期间的心理社会支持以及获取障碍，会影响脱离寄养照顾后的心理健康服务利用情况。结果表明，需要采取策略来：1）帮助青少年和临床医生就心理健康治疗需求和选择达成共同理解；2）将心理健康纳入过渡计划；3）解决脱离寄养照顾后获取心理健康服务的保险及其他系统性障碍。
