Access Type

Open Access Dissertation

Date of Award

January 2014

Degree Type


Degree Name




First Advisor

Valerie Simon


Underutilization of mental health services by ethnic minorities has been identified as a major public health threat by the U.S. Department of Health and Human Services (2001). Research on ethnic disparities has focused on identifying the sociodemographic correlates of between group differences in treatment attendance. The current study adds to the utilization literature by exploring within group differences amongst a sample of African-American families. Based on extant literature related to treatment utilization in other samples, this study examined the associations between multiple modifiable factors and adolescent treatment engagement amongst 90 African-American caregiver-adolescent dyads.

Consistent with previous research, psychological symptoms, functional impairment, and caregiver strain were each associated with increased odds of adolescent treatment. Caregiver ratings were more strongly related to treatment than youth ratings. Caregiver rating of youth functional impairment and caregiver strain each contributed uniquely to the likelihood of adolescent treatment, even when considering the current gold standard of psychological symptoms. With respect to prohibitive factors, more negative caregiver attitudes towards youth treatment were associated with a decreased likelihood of adolescent treatment. Negative caregiver attitudes towards treatment added unique information to the likelihood of treatment engagement even when controlling for caregiver ratings of youth functioning. Youth report of barriers to treatment and caregiver report of social stigma showed trends towards significance in predicting treatment engagement. Self-stigma did not show any associations with treatment, and stigma did not moderate the associations between the facilitative and prohibitive factors and adolescent treatment.

These findings point to the importance of considering caregiver perspectives on youth functional impairment and caregiver strain in addition to psychological symptoms when engaging families in treatment. Further, it is important to target negative caregiver attitudes, negative caregiver social-stigma, and youth perceptions of barriers to treatment in efforts to increase adolescent treatment utilization. With respect to research, there is a need to develop measures that capture the nuances of stigma that are often reflected in qualitative research studies among African-American populations. Overall, this study highlights the need for increased psychoeducational and outreach efforts to incorporate African-American youth and families in both clinical services and research in order to increase adolescent mental health service utilization.