title: Mental health beliefs and barriers to accessing mental health services in youth aging out of foster care.
abstract: OBJECTIVE
  To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care.
  
  
  METHODS
  Focus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the "threat of mental health problems," treatment benefits versus barriers to accessing mental health services, self-efficacy, and "cues to action." Data were analyzed using a modified grounded-theory approach.
  
  
  RESULTS
  Youth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports "cueing action" during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation.
  
  
  CONCLUSIONS
  Youths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care.
authors.affiliation: Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Mass. Electronic address: csakai@tuftsmedicalcenter.org.
authors.forename: Christina
authors.initials: C
authors.lastname: Sakai
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass.
authors.forename: Thomas I
authors.initials: TI
authors.lastname: Mackie
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Tex; Children's Medical Center, Dallas, Tex.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Shetgiri
authors.affiliation: Children's Medical Center, Dallas, Tex.
authors.forename: Sara
authors.initials: S
authors.lastname: Franzen
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Tex; Children's Medical Center, Dallas, Tex.
authors.forename: Anu
authors.initials: A
authors.lastname: Partap
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Tex; Children's Medical Center, Dallas, Tex.
authors.forename: Glenn
authors.initials: G
authors.lastname: Flores
authors.affiliation: Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Mass; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass.
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
mesh_terms: D000293:Adolescent; D005260:Female; D017144:Focus Groups; D005581:Foster Home Care; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008484:Medicaid; D008605:Mental Health Services; D036301:Qualitative Research; D013781:Texas; D014481:United States; D055815:Young Adult
keywords: foster care; health care transition; mental health; qualitative research