Date of Graduation

5-2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology (PhD)

Degree Level

Graduate

Department

Psychological Science

Advisor/Mentor

Ana J. Bridges

Committee Member

Timothy Cavell

Second Committee Member

James Lampinen

Keywords

integrated primary care (IPC), treatment barriers, health disparities, access, behavioral health services, behavioral health screening

Abstract

High need, low access, and rising health care costs reveal the inadequacies of the current mental health system in the U.S. Racial/ethnic minorities, including Latinxs, face substantial disparities in accessing mental health treatment compared with non-Latinx Whites. Integrated primary care (IPC) offers an alternate model for meeting mental health needs by providing care in a way that is accessible to the general population. Though it has been suggested that IPC may reduce health disparities by decreasing barriers to mental health treatment, empirical data relevant to this question are limited. A series of three studies were conducted using a mixed methodology approach to better understand how the primary stakeholders in the mental health system, potential recipients, perceive barriers to accessing mental health treatment by setting (IPC or specialty mental health [SMH]) and whether this process varies by Latinx or non-Latinx White ethnicity. In Study 1, a sample of 95 IPC patients completed a brief structured interview regarding their perceptions of barriers to remaining in IPC for continued treatment versus receiving a referral to SMH. Results showed a main effect of setting, with fewer barriers ascribed to accessing IPC than SMH; a setting by ethnicity interaction revealed Latinx patients endorsed greater barriers to SMH than did non-Latinx White patients. In Study 2, a sample of 13 IPC patients participated in qualitative telephone interviews focused around their experience of barriers and care in IPC. The themes that emerged in the coding of qualitative data suggested patients found behavioral health treatment in IPC to be accessible, particularly for individuals with little knowledge of mental health services, maintained a positive impression of care received, and considered the practical elements of the IPC model of service delivery to be acceptable. However, some Latinx patients were more likely to express dissatisfaction with care related to interpersonal aspects of their interactions with behavioral health providers. In Study 3, a sample of 97 non-treatment seeking participants were recruited from a local cultural festival and randomly assigned to complete a questionnaire regarding their perceptions of barriers to receiving mental health treatment in either the IPC or SMH setting. Non-treatment seeking individuals did not endorse a difference in barriers by setting, nor was ethnicity associated with a differing report of barriers to care. Overall, it appears IPC patients perceive behavioral health treatment delivered in primary care to be satisfactory, beneficial, and successful in reaching individuals with mental health need who otherwise may not receive care. Non-treatment seeking individuals, who may have lower mental health need and less experience attempting to access care, do not identify a difference in barriers between the IPC and SMH settings. Findings suggest delivering care in the IPC setting can be an effective method of service delivery with the potential to reduce barriers to care, although key elements of IPC may need to be addressed to increase acceptability across all population subgroups.

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