There are a multitude of treatment barriers that arise when addressing behavioral problems in adolescents. These barriers are apparent in family, adolescent, and clinical domains. These issues range from attitudes towards treatment services, the captured understanding of mental health, treatment reliance, systemic views, family circumstances, cultural and ethnic underrepresentation, and the available access to these treatments based upon practical obstacles. The limited access and effectiveness in treatment among adolescent behavioral problems has been examined from a multi-faceted perspective. The presence of these treatment barriers is detrimental to all aspects of the system involved in the desire to treat the behavioral problems which includes the adolescent, parent, and clinician.
Adolescents receiving treatment have expressed the most evident barriers being negative staff attitudes, reoccurring changes in staff, and long-waits prior to their treatment. A research study by Oruche (2014) reported that these factors of poor treatment management led to significantly higher rates of treatment dropout among teens. It was conversely relayed that consistent communication, strong adolescent and parent relationships during session, and respectful staff decreased the rate of treatment dropout. It was suggested by both the adolescent in treatment and their parent that caregiver support groups, automated appointment reminders, informed education of mental health, and clinic transportation could further reduce the frequency of treatment dropouts among adolescents (Oruche, 2014). Another research study (Lynn, 2006) considered the treatment barriers stated by both the adolescent as well as their therapist in a conjoined manner. Both parties identified that the most interventional barriers were the compatibility of treatment and the adolescent, a lack of treatment readiness, and practical obstacles. The level of treatment relevance, comfortability, interpersonal connectedness, and means of transportation also contributed to what was classified as a barrier by the paired adolescent and therapist. A notable barrier that exists outside of the treatment itself is the strength of the relationship between the therapist and adolescent. Weaker relationships indicated a higher likelihood of a shorter and unwanted treatment duration while stronger relationships were correlated with a more desirable attitude to continue treatment by the adolescent (Lynn, 2006).
Parents felt more inclined to focus on barriers such as family beliefs and attitudes towards treatment, the reality of treatment not meeting expectations, issues regarding access to treatment, the help-seeking process, and structural views. A research study (Smith, 2013) surveyed parents or guardians of their inpatient youth. The methods involved asking parents three-open ended specific questions of “What other issues have you faced in trying to get the mental health treatment you need for your children/adolescent,” “What suggestions would you have that may help parents/guardians to receive the mental health services that are recommended for their children/adolescents?” and “Comments about coming to treatment?” (Smith, 2013). From these questions, it was concluded that barriers to treatment that parents perceived as most problematic was based upon the progress of improvement in their child’s behavior. Other barriers that upheld by parent’s attitudes were how effective the treatment was, how negatively the parent’s stress was affected by the treatment of their child, and if other behavioral problems arose in their children despite receiving treatment. These findings suggest that the treatment barriers that appear most threatening to parents have little correlation with the product, effectiveness, and improvement seen in their child’s behavioral problem. A lack thereof is noticeable treatment outcome amplified the severity of what barriers can be identified in treatment by parents and guardians (Smith, 2013).
Clinician views towards what treatment barriers exist are aimed at adolescent and parent domains as well as the absence of outreach programs designed to reduce the stigma surrounding seeking help for mental health issues. A research study (Robin, 2012) found that adolescent adherence was a primary prohibiting factor to treatment effectiveness which increases the rate of treatment dropout. However, evidence showed contrasting treatment barriers within the adolescent and parent domain as previously supported in other research articles (Oruche, 2014; Lynn, 2006; Smith, 2013; Reardon, 2017). The barriers existing in the adolescent domain focused on the severity of their presented symptoms, the perception of the adolescent, a younger age, gender, ethnic minorities, and client pathology. However, family domains identified parent perception, lack of family networking and support, financial limitations, overall treatment access difficulties, and parental stress and demands as being barriers to treatment outcome. The clinician point of view as to what accurately classified as a treatment barrier included two causes. The first cause being consistent and committed attendance to treatment with the second being present attentive effort shown in participating in treatment. This study emphasized the importance of therapeutic alliance which demonstrates how close and strong a relationship exists between the clinician and the adolescent. A majority of the clinicians supported the evidence of stronger relationships with their clients indicating a longer period of time spent in treatment and a higher engagement during treatment sessions (Gearing, 2012).