Service use and barriers to care for youth with serious behaviour problems: a longitudinal study

The current study examined the longitudinal mental health needs of males and females with serious behaviour problems and their experiences with services. Study One assessed the mental health profiles of youth in adolescence (N = 141; M = 15.28, SD = 1.42) and young adulthood (N = 69; M = 19.85, SD = 1.42). Rates of service use and barriers to care were examined quantitatively in young adulthood. Study Two further explored youths’ experiences with services through an in-depth qualitative interview (N = 19; M = 23.56, SD = 1.52). Study One results demonstrated that mental health problems persisted from adolescence to young adulthood. Approximately half of participants endorsed clinically-elevated externalizing problems (substance dependence, antisocial behaviour, ADHD) and a third endorsed clinically-elevated internalizing problems (depressive and PTSD) in young adulthood. Externalizing problems appeared to be more stable than internalizing problems from adolescence to young adulthood. Despite this need, only 53% of participants in young adulthood accessed services and 43% reported at least one barrier to care. Study Two provided detailed accounts of youths’ life histories, experiences with services and barriers to care. Participants reported experiencing severe child maltreatment, highlighting the need for early intervention services that protect youth from harm. Results pointed to the need for youth-centered services that are strengths-based, flexible, and use a harm-reduction approach. Youth preferred service providers who were empathic, patient, consistent and non-judgmental. The barriers to care themes were complex and occurred at the structural (e.g., lack of availability), familial (e.g., caregivers impacted their ability to access services), and individual (e.g., negative expectation of therapeutic relationship) levels. Findings are interpreted based on youths’ histories of harmful interpersonal relationships and traumatic experiences. Clinical and policy recommendations are discussed.