Associations between Maternal Reflective Functioning and Child Mental Health Treatment Engagement

• In Event: Poster Session 11
  In Poster Session: PS 11 Topic - Family Context & Processes

Abstract

According to NIMH (2017), approximately 20% of children experience a psychological disorder before the age of 18, putting them at greater risk for later substance abuse, high-school dropout, early parenthood, incarceration, and unemployment (Copeland, Wolke, Shanahan & Costello, 2015). Unfortunately, fewer than half of all children with mental health (MH) needs receive treatment (Whitney & Petersen, 2019). As with adults, there are pragmatic, psychological, and systemic factors that contribute to this treatment gap. For children, however, there are additional barriers associated with parents’ understanding of children’s behaviors. Research suggests that maternal reflective functioning (RF) may be one such factor.

Reflective Functioning allows us to infer and verbally represent internal states in ourselves and others (Fonagy et al., 2016). Among adults, lower RF is associated with less therapy utilization and therapeutic alliance (Ekeblad, Falkenström, & Holmqvist, 2016; Löffler-Stastka, Blueml, & Boes, 2010). In mothers, lower RF is associated with more negative views of child therapy efficacy; among mothers who believe their child has MH needs, lower RF predicts less likelihood of subsequently engaging in services (Carlone & Milan, 2020). Low maternal RF may impact child MH treatment engagement. Reflecting on the reasons for behaviors might help parents increase their trust in the effectiveness of addressing these underlying mental states through MH treatment. However, empirical evidence is still limited.

The current study aimed to replicate findings from Carlone and Milan (2020) in a sample at greater clinical risk. Participants included 242 mothers (25% non-White) with a previous mental health diagnosis (71% Anxiety; 66% Depression) and a child between age 3-18. Mothers completed an online survey including the Reflective Functioning Questionnaire (Fonagy et al., 2016), BASC-3 Behavioral and Emotional Screening System (BESS; Kamphaus & Reynolds, 2015), and Perceived Need and Use of Therapy (Carlone & Milan, 2020). ANCOVAs and logistic regression testing moderation were used for analyses.

Across the sample, RF was significantly correlated with perceptions of the effectiveness of child therapy (r = .25) but not adult therapy (r = .11). Among mothers who believed their child had MH needs, mothers currently utilizing services reported higher RF than mothers not utilizing services, controlling for various confounds (i.e. maternal education and MH service utilization history, and child age and gender; F = 3.45, p < .05). In tests of moderation, the extent to which BESS scores predicted current MH treatment varied based on RF. Among mothers reporting high levels of child maladjustment, current child MH treatment was highest when mothers reported high RF versus low RF (36% vs. 11% in services).

These findings provide additional support that parental RF may influence beliefs and decisions about child MH treatment. If so, RF-based activities with higher risk families (e.g., encouraging parents to consider how internal experience motivates their own and their child’s behavior) may be one mechanism for facilitating treatment engagement. Given the vast unmet need in children’s MH, developing evidence-based strategies to promote treatment engagement should be a priority.

Authors

• Karla Damaris Rivera-Figueroa, University of Connecticut
  Presenting Author

• Ana Luisa Barbosa Torreao Dau, University of Connecticut
  Non-Presenting Author

• Stephanie Milan, University of Connecticut
  Non-Presenting Author