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Mental Health Disparities

(PS7-D87) Barriers to Mental Health Care Among Rural New England Families with Children with ADHD

Saturday, November 18, 2023
8:30 AM – 9:30 AM PST
Location: Regency Ballroom, Level 7


Introduction: Attention Deficit/Hyperactivity Disorder (ADHD) affects a large portion of children under age 8 in the United States (Bisko et al., 2022). Behavioral parent trainings (BPTs) are efficacious treatments, but few families with young children diagnosed with ADHD engage in treatment (Bussing et al., 2003; Katoaka et al., 2002). Low engagement may be a result of tangible barriers, including the cost of care and lack of transportation, and intangible barriers, such as a lack of trust in the health system or mental health stigma (Larson et al., 2013; Reardon et al., 2018). Fewer resources within rural communities and increased travel costs and time demands are known to be salient barriers to rural populations engaging in mental health care (Pullman et al., 2009). These barriers may be particularly problematic for engagement in BPTs, given the necessity of parent engagement in this mode of treatment. This study aims to explore the challenges rural families with children with ADHD face and compare their responses to prior work on urban family engagement using similar methods. To date, no research has been done to identify barriers specific to this population.

Method: We recruited rural families with children aged 3-7 diagnosed or suspected to have ADHD to complete the Barriers to Care Scale at the time of referral to BPT. The measure, adapted from Larson et al. (2009), consisted of 24 items assessing tangible barriers (ɑ=.830) (e.g., cost, transportation, provider availability) and intangible barriers (ɑ=.746) (e.g., attitudes, stigma, trust). The ADHD-5, the impairment rating scale, and key demographics, including income, distance to care, and race, were also collected.

Results: As of March 2023, 30 of an anticipated 60 respondents have completed the study, and we anticipate having our full sample by July 2023. Preliminary findings show less than half of our sample had previously sought out mental healthcare (47%), of which only 29% reported having received some kind of therapy in the past. Families lived a median distance of 67 miles from the medical center where they received care. About a quarter (26%; n=6) of families qualified for low-income housing with a yearly household income of $50,000 or less. Preliminary analyses revealed the lack of appointment times, difficulty in missing work, and not knowing where services were located were the most problematic tangible barriers. The most endorsed intangible barriers included concern about the quality of mental health care in the area and distrust in providers. Rural families face more tangible barriers (e.g., access to care, transportation) when accessing care compared to a similar study of urban families (Larson et al., 2009).

Discussion: Our results suggest that high-quality, trusted, low-cost options, such as telehealth through a trusted source such as schools or primary care, may be a good match for this population. Providing telehealth care and meeting families ‘where they are’ would greatly reduce tangible barriers to ADHD care. Future research should continue to explore the nuances of barriers for this population and construct treatments with these barriers in mind.
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