Caregiver Perspectives on Barriers to Accessing Behavioral Health care: Opportunities and Challenges for Pediatric...

Families with young children have regular, frequent interactions with pediatric primary care across early childhood. Thus, pediatric primary care is an ideal setting to prevent mental and behavioral health disorders through supporting access to behavioral health care services. Exploring the barriers families with young children face in accessing behavioral health care services will support insights into potential strategies to improve access through primary care settings.

Semi-structured qualitative interviews were used to explore the perspectives of 27 caregivers of young children (ie, ages 0-5 years) regarding access to behavioral health care. Participants were recruited from a large pediatric clinic affiliated with a pediatric residency program serving a high proportion of Medicaid-eligible families (>85%). Deductive and inductive methods were used to develop a codebook followed by content analysis to identify and characterize access barriers.

Qualitative content analysis revealed several interconnected barriers families face accessing behavioral health care services for their young children. Barriers were organized into the categories of logistical, financial, and psychosocial. Logistical barriers included 1) childcare, 2) time, 3) transportation, and 4) employment-related issues. Financial barriers included 1) inadequate insurance coverage, and 2) broader financial constraints. Psychosocial barriers included 1) education and understanding of behavioral health issues, 2) anxiety or shame, 3) judgment, and 4) mistrust of health care providers.

Improving access to behavioral health care services through pediatric primary care settings will require a multifaceted approach that addresses logistical, financial, and psychosocial barriers. Solutions should consider systemic and individual factors, promote behavioral health education, and reduce stigma.