Date Approved

2025

Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School

Psychology

Committee Member

Heather Janisse, PhD

Committee Member

Heather Janisse, PhD

Committee Member

Stephen Jefferson, PhD

Committee Member

Luke Tornier, PsyD

Abstract

Research has found that pediatric integrated behavioral health (IBH) significantly increases utilization of behavioral health services, but there are still families who are missing out. The purpose of the current study is to examine characteristics that may influence or impede utilization of an IBH referral. Phase 1 utilized survey methodology paired with electronic medical record review in a sample of 24 caregivers to pediatric patients to investigate whether parent-reported perceived stigma of accessing mental health care, barriers to accessing health care in general, and child symptom severity uniquely predicted referral utilization. Phase 2 used electronic medical record data in a sample of 461 pediatric patients to examine how demographic characteristics uniquely predicted referral utilization. Both phases examined these variables across three distinct primary care clinics, including a rural clinic and two suburban clinics that differed on population characteristics. Phase 1 findings found that parents who perceived their child’s behavioral health symptoms as more severe were more likely to utilize the IBH referral. Phase 2 found that referral utilization was higher within this IBH model of care (48%) compared to rates of referral utilization for traditional outpatient therapy (20%). The rural clinic had the highest rate of referral utilization while the suburban clinic that serves a predominantly Medicaid population had the lowest referral utilization rate. Video visits increased referral utilization for both the rural clinic and the well-resourced suburban clinic. Girls were more likely to utilize their behavioral health referral than boys in the rural clinic. There have been few studies conducted that have examined the utilization of IBH services in rural primary care clinics. The findings from this study have implications for how to support patients and communities to better access behavioral health care.

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