Repeated Engagement in Help-Seeking Behavior of Children and Adolescents with Mental Illness in a Sociocultural Context

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Abstract

This study aims to theorize help-seeking behavior of children and adolescents with chronic mental illness in the intersection of parent-child attachment and a sociocultural context. Based on the alternative theory, we further estimated the effect of repeated engagement on child health outcomes. Using data from 15,109 episodes of care (EOC) treated by Intensive In-home Children and Adolescent Psychiatric Services (IICAPS) between 2011-2018, we estimated the effect of repeated admissions to intensive in-home psychiatric services on behavioral outcomes and medical service utilization. Multilevel mixed effects models indicated that repetition of psychiatric treatment was associated with marginal benefits in improving child’s functioning, managing symptom severity and reducing the likelihood of being hospitalized. To control for fixed effects at the level of episode of care (EOC), the analysis considered information regarding age at intake, initial status regarding target outcomes, duration and service intensity, completion of treatment and referrals to higher level of care at the time of discharge. At patient level, the analysis considered patient-specific factors such as race/ethnicity, sex, trauma history and caregiver relationship. Meanwhile, analytical models also specified random effects at both levels of patients and the geographic location where services were provided. Results show that repeated engagement has positive effects on treatment outcomes contingent upon the completion of required treatment when compared to other cases of one-time clinical engagement. Biological parent engaged in the process of help-seeking appeared to be associated with the positive effect of repeated clinical intervention despite children’s trauma history, holding all other factors constant. While Black male children and adolescents distinctively demonstrated additive gain through repetition, it is arguably tied to parental perception on child’s behavior in social context and the subculture of familism. Overall, findings suggest that it is critical to strengthen parental agency and parent-caregiver attachment for child health outcomes.

Authors

• Soyon Kim, Yale University

• Bridget Torres, Yale Child Study Center

• Jean Adnopoz, Yale Child Study Center

• Joseph Woolston, Yale Child Study Center