title: A qualitative evaluation of barriers to care for trauma-related mental health problems among low-income minorities in primary care.
abstract: This study aimed to identify barriers and facilitators of mental health care for patients with trauma histories via qualitative methods with clinicians and administrators from primary care clinics for the underserved. Individual interviews were conducted, followed by a combined focus group with administrators from three jurisdictions; there were three focus groups with clinicians from each clinic system. Common themes were identified, and responses from groups were compared. Administrators and clinicians report extensive trauma histories among patients. Clinician barriers include lack of time, patient resistance, and inadequate referral options; administrators cite reimbursement issues, staff training, and lack of clarity about the term trauma. A key facilitator is doctor-patient relationship. There were differences in perceived barriers and facilitators at the institutional and clinical levels for mental health care for patients with trauma. Importantly, there is agreement about better access to and development of trauma-specific interventions. Findings will aid the development and implementation of trauma-focused interventions embedded in primary care.
authors.affiliation: Intramural Research Program, National Institute of Mental Health, Bethesda, MD 20892-1276, USA. chungj@mail.nih.gov
authors.forename: Joyce Y
authors.initials: JY
authors.lastname: Chung
authors.forename: Lori
authors.initials: L
authors.lastname: Frank
authors.forename: Asha
authors.initials: A
authors.lastname: Subramanian
authors.forename: Steve
authors.initials: S
authors.lastname: Galen
authors.forename: Sarah
authors.initials: S
authors.lastname: Leonhard
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011203:Poverty / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*