Knowledge of youths' access to mental health services is an underdeveloped, but nationally important, issue that will impact the way youths' services are funded and provided. This research career proposal addresses youths' entry into and pathways through mental health services provided by both specialty and nonspecialty sectors (mental health, public health, child welfare, juvenile justice, education, and drug and alcohol). To date, services research has neglected the role of social workers and nonspecialty mental health professionals in the provision of mental health services. A K02 Award will allow Dr. Stiffman the time to build upon her previous work, adding breadth to its significant contributions in this area. The research will test hypotheses with data from ongoing studies and address knowledge needed to provide better access to mental health services in multiple service sectors. The hypotheses relate to service access; the role of the gateway provider, and Medicaid/managed care: 1. Youths' use of services for their mental heath problems is determined by: their need, their predisposing characteristics, and service enabling characteristics; 2. Youths' access to services for their mental health problems is determined by: their need as perceived by gateway providers; and those gateway providers' resources, service connections, and service knowledge; 3. The use of specialty mental health services is positively associated with the availability and accessibility of Medicaid and managed care reimbursed services. This study will also explore service access questions about which too little is yet known to frame specific hypotheses, but which are important to improving access and delivery of services. During the K02, exploratory analyses will help frame these as hypotheses for new studies: 1.) What are the multisector configurations of services and their complementary or supplementary relationships?; 2.) What is the relationship of problem persistence to service configuration change over time? and; 3.) What is the relationship of barriers (which will change over time) to changes in service configurations?
