Date of Graduation


Document Type


Degree Name

Doctor of Philosophy in Psychology (PhD)

Degree Level



Psychological Science


Ana J. Bridges

Committee Member

Lindsay S. Ham

Second Committee Member

David A. Schroeder


Barriers, Follow-up, Help Seeking, Integrated Behavioral Health Care, Mental Health, Perceived Need


Structural and attitudinal barriers prevent many individuals from accessing professional mental health services and often times lead to the premature termination of treatment. Although research findings suggest that the integration of mental health services in primary care can increase access to services and reduce stigma for typically underserved populations, dropout occurs at high rates. The current study aims to: (1) identify correlates of attitudinal and structural barriers in a primary care setting, and (2) test the ability of the Integrated Model of Seeking Help (IMoSH) to predict follow-up for behavioral health visits. In particular, it was hypothesized that attitudinal barriers would predict behavioral intentions to return to a recommended appointment. On the other hand, structural barriers would better predict dropout for patients who had greater intentions of returning to their behavioral health appointment. Participants (N = 100) were recruited from two primary care clinics. During their initial contact with behavioral health services, patients rated their perceptions of attitudinal and structural barriers to treatment continuation, perceived need, and intention to return for a follow-up appointment. Electronic medical records indicated that 50% of patients attended their recommended follow-up appointment. Correlational analyses did not identify any significant correlates of attitudinal barriers. However, Spanish language preference was related to the endorsement of more structural barriers. Findings from a path analysis testing the IMoSH’s ability to predict follow-up demonstrated that neither attitudinal barriers or structural barriers predicted behavioral intentions or follow-up, and structural barriers did not moderate the relation between behavioral intentions and follow-up attendance. Post hoc analyses revealed that a model including perceived need was able to predict follow-up attendance. The preliminary results of this study can help mental health service providers identify where efforts should be placed during patients’ first visits in order to increase treatment engagement and improve continuity of care.