Perceived Barriers to Help-Seeking Among Parents of At-Risk Kindergarteners in Rural Communities

Abstract

This study examined help-seeking and perceived barriers to children's mental health service utilization in a large sample of parents living in rural communities who are at various stages in the help-seeking process. The goals were to (a) obtain a demographic profile of at-risk kindergarteners and their parents, (b) examine parent-reported help-seeking behaviors, and (c) assess barriers to mental health service use. Parent and teacher report of the Behavior Assessment System for Children, Second Edition, were used to screen children (N = 597) at kindergarten entry and to identify their risk status. Parents also completed the Barriers to Participation Scale and reported the frequency of help-seeking behaviors related to their child's problems. Using a cutoff score of 1.5 standard deviations above the mean, nearly half (51%) of children were identified as at-risk (76% low risk, 24% high risk) for emotional, behavioral, social, and adaptive problems. Barriers and help-seeking did not differ across parents of low and high risk children. Among parents of at-risk children, only 33% believed their child had a problem. Parents sought informal help more often than professional help; however, medical doctors and school staff were sought most among professionals. The majority of parents (61%) endorsed at least one barrier that would interfere with mental health service use. Results highlight the importance of early school mental health screening and the need for interventions to increase parent problem recognition and engagement in mental health service utilization.

Acknowledgments

We thank the children, parents, teachers, school administrators, and university students who participated in and supported this project.

Notes

Note: Hollingshead scores ranged from 6 to 62. Low Risk = identified by parent or teacher through Behavior Assessment System for Children, Second Edition (BASC–2); High Risk = identified by parent and teacher through BASC-2; Appalachian heritage = caregiver's report that they, their parents, or grandparents grew up in Appalachia (southeast Ohio, West Virginia, eastern Kentucky); HS = high school; I = unskilled laborers, menial service workers; II = machine operators, semiskilled workers; III = skilled craftsmen, clerical, sales workers; IV = medium business, minor professional, technical; V = major business and professional; TFI = Total Family Income; IRS = Impairment Rating Scale.

^a N = 291.

^b N = 233.

^c N = 73.

^d N = 306.

^e N = 597.

^f Denotes a significant group difference between on track and total at-risk (p < .001).

^g Significant difference between low and high risk, p < .05.

^h Significant difference between low and high risk (p < .001).

*Significant difference between parent and teacher ratings (p < .001).

Note: Lower adaptive subscale scores (adaptability, functional communication, social skills, activities of daily living) indicate higher symptomatology; activities of daily living completed only by parents.

^a N = 291.

^b N = 306.

^c N = 291.

^d N = 306.

Note. Parents could endorse more than one option within each category, thus percentages do not total to 100%. Low Risk = identified by parent or teacher through Behavior Assessment System for Children, Second Edition (BASC-2); High Risk = identified by parent and teacher through BASC-2.

^a N = 233.

^b N = 73.

^c N = 306.

**Significant difference between informal and professional help for total risk children, p < .001 (boldface text).

Note: Mean item scores for subscales with different superscripts ( ^d through ^g ) are significantly different from each other (p value adjusted [.05/4] = .01; all ps < .001). Barriers to Participation Scale (BTPS) scores ranged from 44 to 147. Barrier endorsed if parent indicated occurred either “a fair amount” or “a lot.”

Low Risk = identified by parent or teacher through Behavior Assessment System for Children, Second Edition (BASC-2); High Risk = identified by parent and teacher through BASC-2.

^a N = 233.

^b N = 73.

^c N = 306.