Transforming Mental Health Care, Research Paper Example

Background

Research has shown that approximately 20% of children have a mental health condition and that 10% of children have emotional or behavioral disorders that are severe enough to cause substantial impairment in home, school, and/or community functioning. Unfortunately, research has also revealed that an alarming 75% of children with emotional and behavioral disorders do not receive specialty mental health service.[1]Parents play an essential role in their children’s access to mental health care.  Studies have shown that children and adolescents turn to their parents first when they experience mental health problems. Furthermore, it is rare for children and adolescents to seek professional health care on their own and they are hesitant to seek help in general alone.[2] Help seeking by children is also a function of age: The younger children are, the less likely they are to seek help without the involvement of their primary caregivers.[3]  These findings show that children are highly unlikely to receive mental health care unless their parents find them the help that they need.

Theory

The Integrative Model of Behavioral Prediction (IM) holds holds the belief that action/behavior is primarily determined by one’s intentions. Intentions are a function of three variables: attitudes determined by the beliefs about the positive or negative associations with preforming a “target behavior”; expectations of how those close to the individual will perceive that action (perceived norm); perceived control (self-efficacy).  Intentions to preform a behavior are influences by the specific beliefs the individual has about that behavior. Additionally, IM takes into account an individual’s knowledge and skills that enable them to perform the behavior, as well as their environmental constraints.  IM holds that people will act on their intentions when they have the knowledge/skills and are not blocked due to environment constraints.[4]

Recently, it was proposed that IM be used as model in promoting help-seeking among mother’s suffering from Postpartum Depression (PPD). IM was used to look at unsolicited online stories written by mothers whom experienced postpartum depression. Found that many of these common themes in these stories surrounding help-seeking reflected elements in IM: self-efficacy, positive/negative behavioral beliefs, social norms, knowledge about illness etc.  The authors propsed that IM be used as a method to address help-seeking behavior.[5]

Program

Project Thrive is a program that will take place within an elementary school. Project Thrives goal is to increase help-seeking behavior on the part of parents for their children. Thrive will be facilitated in an elementary school. Teachers and nurses will be asked to recommend students who show signs of mental health conditions such as anxiety, depression or behavioral disorders. One children are identified invitations to a parent group will be given to parents of these children. Group discussions and activities will focus on improve perceived self-efficacy in help-seeking, encouraging positive attitudes about help-seeking and mental health services, and educating parents about childhood disorders, and educating parents about the possible consequences of untreated diagnoses.

A previous study done on Multifamily Psychoeducational Groups demonstrated that knowledge of the childhood disorder and increased positive beliefs about treatment resulted higher treatment utilization rates.[6]  It was not disclosed what the primary focus of the group activity/discussion surrounded.  Education alone is not sufficient there must also be a change in beliefs and attitudes.  In one study, parents were given two narratives about a child who showed symptoms of mental health issues.   The only difference in the narratives was that in one scenario the child was a friend’s and in the other the child was their own.  The study found that parents were more likely to refer someone else’s child for psychological help than they were their own.[7] This indicates that knowledge about the severity of an illness or the presence of an illness is not sufficient – there needs to be a change in the beliefs and attitudes forming the behavioral intentions.

The program will target the major beliefs and attitudes that are barriers to help-seeking on the part of parents.  These barriers include: fear of judgment from other parents/family/friends, belief that the parent can “handle” the situation, belief that the child will “grow out of it”, and the belief that the child’s behavior is “problem-oriented” not “illness-oriented”.[8][9]Education about the disorders and the possible consequences of lack of treatment should help to change the attitudes/beliefs as well.  If individuals become more educated they are more likely to understand and believe that these disorders require medical attention and thus act on those attitudes/beliefs.  Education will also help change the belief that the child just has “problem behavior”.  Education will include symptoms of these diagnoses, which will allow parents to see the behavior in a more illness-oriented manner.  Increasing the amount of positive behavioral beliefs and decreasing the amount of negative behavioral beliefs will contribute to the individuals “intention” and result in more positive health behavior.

The program will also provide parents with community resources for their children.  The program will have multiple resources and resources tailored to specific diagnoses.  Encouragement from the group and staff will help to increase self-efficacy among these parents. The activities and discussions during group meetings will assist in encouraging more positive attitudes toward help-seeking.  The program will also serve as a support network and sense of community in the participants.  The hope is that this newfound sense of community will generate more positive beliefs and create a new “social norm” that encourages help-seeking.  Even if the program cannot change the beliefs of larger society (general normative belief), the impact of the group can help to take that action despite possible disapproval from others.

Evaluation

Evaluation of this program will be modeled off of an evaluation of another IM program.[10]the parents will be given a survey the first day of the group to measure their: self efficacy, positive behavioral beliefs, negative behavioral beliefs, general normative belief, behavioral attitude, subjective social norm, intention, and number of times they displayed help-seeking behavior.  This survey will be given every month and will assist in evaluating the effectiveness of this program.  Set backs may occur in that parents may not want (or be able) to attend the group. Early dropout could be another setback that could affect group moral.

Summary

Project Thrive will lead to an increase in help-seeking among parents attending the program.  Project Thrive works to increase self-efficacy, create more positive behavior beliefs, create a new social norm (within group), increase knowledge, provide geographically appropriate resources, and influence the behavioral attitude toward one more positive about help-seeking. All of these things contribute to shaping the individual’s intention, which drives their behavior.  In IM intentions shape our behavior. Using an IM approach to target these areas will aide in creating help-seeking intentions that will turn into help-seeking behavior.

[1] Huang L, Stroul B, Friedman R, Mrazek P, Friesen B, Pires S, Mayberg S. Transforming Mental Health Care for Children and Their Families. American Psychologist, 2005;60(6):615- 627.

[2]Rothi DM, Leavey G. Mental Health Help-Seeking and Young People: A Review. Pastoral Care Education, 2006;24(3):4-13.

[3] Farmer EMZ, Burns BJ, Philips SD, Angold A, Costello EJ. Impact of Children’s Mental Health Problems on Families: Relationships with Service Use. Journal of Emotional and Behavioral Disorders. 1997;5:230-238.

[4]Edberg MC. Essentials of Health Behavior 2^nd Ed.  Burlington, MA: Jones & Bartlett Learning; 2013.

[5]Thomas L, Scharp K, Paxman C. Stories of Postpartum Depression: Exploring Health Constructs and Help-Seeking in Mothers’ Talk. Women & Health. May 2014;54(4):373-387.

[6] Mendenhall AN, Fristad MA, Early TJ. Factors Influencing Service Utilization and Mood Symptom Severity in Children with Mood Disorders:  Effects of Multifamily Psychoeducation Groups (MFPGs). Journal of Consulting and Clinical Psychology, 2009;77(3):463-473.

[7]Raviv A, Sharvit K, Raviv A, Rosenblat-Stein S. Mothers’ and Fathers’ reluctance to seek psychological help for their children. Journal of Child and Family Studies, 2009;18:151-162.

[8]DosReis S, Mychailyszyn MP, Evans-Lacko SE, Beltran A, Riley AW, Myers M. The Meaning of Attention-Deficit/Hypeactivity Disorder Medication and Parents’ Initiation and Continuity of Treatment of Their Child. Journal of Child and Adolescent Psychopharmacology, 2009;19(4):377-383.

[9]Pavuluri MN, Luk S, McGee R. Help-Seeking for Behavior Problems by Parents of Preschool Children: A Community Study. Journal of the American Academ of Child and Adolescent Psychiatry, 1996;35:215-222.