Important Role In Access Research Articles

Artificial Intelligence in the Future Landscape of Pediatric Neuroradiology: Opportunities and Challenges.

This paper will review how artificial intelligence (AI) will play an increasingly important role in pediatric neuroradiology in the future. A safe, transparent, and human-centric AI is needed to tackle the quadruple aim of improved health outcomes, enhanced patient and family experience, reduced costs, and improved well-being of the healthcare team in pediatric neuroradiology. Equity, diversity and inclusion, data safety, and access to care will need to always be considered. In the next decade, AI algorithms are expected to play an increasingly important role in access to care, workflow management, abnormality detection, classification, response prediction, prognostication, report generation, as well as in the patient and family experience in pediatric neuroradiology. Also, AI algorithms will likely play a role in recognizing and flagging rare diseases and in pattern recognition to identify previously unknown disorders. While AI algorithms will play an important role, humans will not only need to be in the loop, but in the center of pediatric neuroimaging. AI development and deployment will need to be closely watched and monitored by experts in the field. Patient and data safety need to be at the forefront, and the risks of a dependency on technology will need to be contained. The applications and implications of AI in pediatric neuroradiology will differ from adult neuroradiology.

Increasing Telehealth Access to Care for Older Adults During the COVID-19 Pandemic at an Academic Medical Center: Video Visits for Elders Project (VVEP).

BackgroundThe COVID-19 pandemic led to a significant increase in ambulatory virtual care, threatening access to care for older adults with lower digital literacy. This report describes the Video Visits for Elders Project (VVEP), a quality improvement effort to help older adults access video visits at an academic primary care practice.MethodsWe reached out to empaneled older adults (≥ 65 years) who had a scheduled visit between March 30 and June 12, 2020. We assessed patients’ readiness to engage in a virtual visit and offered to walk them through accessing the platform if they owned a compatible device. We evaluated outcomes of those phone calls and actual visit completion.ResultsBetween March 26 and June 3, 2020, we called 1,427 patients, reaching 1,025 (71.8%). Of those reached (mean age 75.6 years), 312 (30.4%) were already video-enabled, 192 (18.7%) asked for technical assistance, 185 (18.0%) did not have access to an electronic device, and 336 (32.8%) declined assistance. Of those reached, 40.4% completed their visit by video, 26.5% by telephone, and 1.4% by in-person visit, while 29.6% canceled and 2.1% no-showed.ConclusionVVEP successfully innovated to promote equitable access to telemedicine for vulnerable older patients in a time of crisis. Almost half required technical assistance or did not have access to a compatible device to engage in virtual care. As telemedicine will continue to play an important role in access to clinical care even in a postpandemic world, it is imperative for health systems to focus on technological need to promote equitable access to care for all patients.

Micromobility, Macro Goals: Aligning scooter parking policy with broader city objectives

Dockless electric scooters challenge cities seeking to regulate them amidst broader goals such as universal access. Cities are particularly concerned with improper scooter parking, which can impede access by other travelers. Despite an important role that scooter parking plays in both regulations and public discourse, no comprehensive view of current scooter parking regulations exists, nor is it clear how regulations align with broader city objectives. This research asks: how have U.S. cities regulated scooter parking to date and what issues do parking regulations aim to address? Data from 37 U.S. cities show that while areas of widespread agreement exist—nearly all (95%) cities allow scooters to park in the furniture zone—a wide range in scooter parking requirements exists. About three quarters of cities allow scooters to park at bike racks (78%) and against buildings (70%), while fewer than two-thirds allow scooters to park either on landscaping (62%) or against signs (60%). Even among cities with similar regulations, however, considerable nuance exists. Interviews with staff from six U.S. cities and existing research highlight motivations for scooter parking regulations. The regulations employed—and the high degree of variability across cities—yield implications for scooter parking policies, as well as scooters’ role in advancing broader city objectives. Scooter parking regulations play an important role in access, but cities should approach regulations as just one piece within a broader agenda of reclaiming streets for people and promoting mobility, sustainability, and access for all.

Conséquences d’un cancer dans l’enfance dans la quête du premier emploi dans l’interrégion Grand Ouest. Étude multiméthodes du groupe Grand Ouest Cancer de l’Enfant (GOCE) chez d’anciens patients et des professionnels

The professional situation of patients treated for childhood cancer differs from country to country. The aim of the study is to study, with the French sociocultural specificities, the first professional integration of these young people. A sequential quantitative-qualitative mixed approach associates 16 individual interviews and responses to a self-questionnaire of 254 young cancer survivors (sex-ratio=1, median age 23.5 years diagnosed between 2000 and 2010; 68% leukemia) to 30 individual and collective interviews of professionals. Results They seem to have had fewer difficulties than the general population to find their first job (33% vs. 44%). Young women had more difficulties, young people thought they had stopped studying too early and those who mentioned their sequelae (mainly psychological and neurocognitive). The qualitative phase shows that, in this context, the information provided during the job interview plays an important role in access to the first job. The study showed a need for information, communication and training for all actors whose main axes could be: i) for young people: learn to introduce themselves and adapt speeches and postures, be aware of their non-obligation to reveal a situation relating to health and to the handicap; ii) for the medical profession: to promote communication and to find spaces for exchanges between specialists, generalists, occupational physicians; iii) for employers: better know the disease and the laws to adapt their eyes and practices.

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BACKGROUND The study was carried out to determine the prevalence of dental caries among urban and suburban population in Pakistan to assess the association of dental caries with oral hygiene status, socioeconomic status, and dental service availability. METHODS A total of 200 patients was enrolled in this cross-sectional study. Decayed, filled, and missing teeth (DMFT), oral hygiene status, socioeconomic status (SES), and presence / absence of dental care facility were recorded. A specially designed proforma was used to record the data regarding oral hygiene practices, dental treatment availability and socioeconomic background, for the study. The data obtained was statistically analysed using SPSS version 15 software. Chi-square test was applied for association between categorical variables. Analysis of variance (ANOVA) was done to test the difference in DMFT scores of various age groups. Student t test was applied to test the difference in DMFT scores in both sexes. RESULTS Comparison of mean D, M and F status revealed a high tendency towards decayed teeth. Mean DMFT score was found to be 4.41. Maximum DMFT was recorded among 50 years and above age group, followed closely (2.39) by 40 - 49 years. Increased caries prevalence was seen in people with poor oral hygiene and belonging to low socioeconomic status. Caries rate was also high in areas with lack of dental care facilities. CONCLUSIONS Oral hygiene practices, dietary habits, and access to dental care services played an important role in prevalence of dental caries. Socio-economic status has been found to play an important role in access to dental care facilities. From the current report, importance for public health was noted; the socioeconomic status, educational status of parents, and family structure, affect oral health in under-privileged communities. The prevalence of dental caries also plays an important role in oral hygiene procedures, eating patterns, and access to dental care services. KEY WORDS Dental Caries, SES, Oral Hygiene, Dental Care Facility, DMFT.

Payment for Contraceptive Services in Safety Net Clinics: Roles of Affordable Care Act, Title X, and State Programs.

We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.

Health literacy level and influencing factors in university students.

Health literacy (HL) competencies vary across different health domains, and so the youth HL level plays an important role in access to healthcare. The aim of this study was to determine HL levels, the factors that affect it and health-promoting lifestyle behaviours of university students. This cross-sectional study was conducted with 905 students in nursing, law and Islamic sciences departments. An introductory information form, European Health Literacy Scale and Health Promoting Lifestyle Behaviors Scale were used to collect research data. The results showed that 45% of the students had a problematic HL level. Each subscale of the HL scale exhibited a significant positive correlation with the subscales of the Health Promoting Lifestyle Behaviors scale. Logistic regression showed that gender and health education were significantly associated with the HL level. We recommend increasing awareness regarding health liability and integrating HL notions into the higher education curriculum.

Websites with Multimedia Content: A Heuristic Evaluation of the Medical/Anatomical Museums

The internet and web technologies have radically changed the way that users interact with museum exhibits. The websites and their related services play an important role in accessibility and interaction with the multimedia content of museums. The aim of the current research is to present a heuristic evaluation of forty-seven medical and anatomy museum websites from usability experts, for the determination of the principal/key characteristics and issues towards the effective design of a museum website. For homogeneity and comparison purposes, the websites of museums with no support of English language were not included in the evaluation process. In the present paper, the methodology was structured with the assessment of the technologies and services of anatomy museum websites in mind. The results of the current statistical examination are subsequently analyzed and discussed.

Using information sources by breast cancer women treated with mastectomy.

BACKGROUND:Awareness of sources of information of mastectomy patients has an important role in accessibility of reliable health information sources, thus, when they get information, they can be effective in the treatment and self-care. The present study aimed to identify the sources of information used by women underwent mastectomy.MATERIALS AND METHODS:The current practical research methodology was qualitative, and research method was conventional qualitative content analysis was performed on 17 patients with breast cancer undergone mastectomy. The sample targeted two hospitals were selected based on criteria of Shaeid Mohammadi and the Persian Gulf and Omid Central chemotherapy in Babdar Abbas. Data were collected by face-to-face semi-structured interviews were conducted in winter 2015. Qualitative content analysis of data was performed at the same time of data collection.RESULTS:Three themes were seemed (medical, interpersonal, and media) sources for explaining the sources of information searching. Subcategories derived from the content of medical (physicians, surgeons, and health workers of health facility centers), interpersonal sources (Family and friends, peers), and media sources (printed, electronic, and Internet).CONCLUSION:Given the importance of information on women underwent mastectomy, and their priority in the use of medical sources, necessitates more attention of health system managers and planners in providing essential information and their accessibility.

Barriers to access improved water and sanitation in poor peri-urban settlements of Abidjan, Côte d'Ivoire.

Achieving access to safe water and sanitation still pose major challenges in urban areas of sub-Saharan Africa countries, despite all the progress achieved in the last decade. This study assessed the ability of populations living in poor peri-urban settlements to access improved water and sanitation and identified factors influencing this access, in order to guide sustainable mitigating solutions to address associated health and environmental risks. We conducted a cross-sectional study in six poor peri-urban settlements of Yopougon, the largest municipality of Abidjan. A total of 556 randomly selected households were included. The factors associated with access to improved water and sanitation were identified through explanatory models using multivariate logistic regression. A proportion of 25% of all households assessed did not have access to clean water and 57% lacked improved sanitation. Socioeconomic status and settlement characteristics appear as the main indicators of poor access to reliable water and sanitation in peri-urban settlements. The presence of the household head’s wife at home was associated with greater access to clean water (OR = 3.57; 95% CI: 1.74, 7.31), thus highlighting the important role of women in ensuring access to clean water in these specific environments. Household size, education and religion were not significantly associated with the two considered outcomes. Women therefore should be involved at all levels of programming in water promotion in these settlements to improve the population’s well-being. While religion does not appear to play an important role in access to water and sanitation, successful interventions should involve religious communities because of their large representation.

Abstract 043: Health Insurance and the Risk of Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis

Background: Health insurance plays an important role in access to medical care and is the focus of extensive policy efforts. We examined the association of health insurance with cardiovascular disease (CVD) incidence. Methods and Results: The Multi-Ethnic Study of Atherosclerosis, sponsored by the National Heart, Lung and Blood Institute of the NIH, followed a US cohort, aged 45-84 without clinical CVD at baseline, for a median of 12.2 years; 788 events occurred among 6,674 individuals. Data were stratified by baseline health insurance status. Kaplan-Meier survival and Cox regression analyses were used to assess the association between health insurance and incident CVD (myocardial infarction, resuscitated cardiac arrest, stroke, CVD death, and angina), adjusting for biomedical CVD risk (traditional risk factors, including age and race/ethnicity, and markers of subclinical atherosclerosis) and socioeconomic status (SES). The majority of individuals had private insurance (51%). Uninsured individuals (9%) were more likely to have untreated hypertension and diabetes, less likely to be on lipid-lowering therapy, and more likely to receive care in an Emergency Department (p < 0.0001). Income, 10-year CVD risk, and 10-year event-free survival varied across insurance groups ( Table ). After adjustment for biomedical CVD risk, individuals with health insurance had a lower risk of incident CVD compared to the uninsured (HR 0.72, p=0.03). However, with additional adjustment for SES (income, education, and employment), insurance was no longer associated with incident CVD (HR 0.78, p=0.12). Among the insurance groups, those with private insurance had a lower risk of incident CVD after adjustment for both biomedical CVD risk and SES (HR 0.70, p=0.03). Medicare and Medicaid coverage were not associated with incident CVD. The military/VA group had a lower risk of incident CVD with adjustment for biomedical CVD risk (HR 0.57, p=0.02) that was no longer significant after adjustment for SES (HR 0.66, p=0.09). Conclusions: The association of health insurance with CVD incidence varied by insurance group, and private insurance was associated with a lower risk of incident CVD. Further exploration of the features of health insurance coverage that impact CVD incidence may facilitate improvements in the primary prevention of CVD.

Agricultural Extension Approaches Influencing Uptake of Improved Sorghum Technologies in Embu County, Kenya

Agricultural extension and technology transfer services play a vital role in disseminating research knowledge, skills and income generating strategies among the farming communities in Kenya. However, there exists a kind of disconnect between the amount of information and technologies developed in research centres and what is implemented by the farmers. The study evaluated the access and use of extension approaches in promoting uptake of improved sorghum technologies. The study systematically selected 129 farmers from four villages. Data on farmers' gender, age, household leadership, occupation and agricultural extension approaches were collected. The study revealed that 83% of the respondents were female out of which, 67% were engaged in improved sorghum production technologies. Besides, 56% young women (20 to 49 years) had embraced the growing of improved sorghum varieties Gadam and Sila 1. Further, mobile phones and radio services were the main means of access to the improved sorghum technologies. In addition, there was a strong positive correlation (r=0.122, P=0.01) between extension approaches and uptake of the sorghum technologies. Besides government agricultural extension agents, visits to progressive farmers and/or research sites and use of demonstration plots contributed to 68% and influenced uptake of improved sorghum technologies. It was concluded that gender, family position and age of the farmer contribute to the uptake of improved sorghum technologies. Moreover, mobile phones and radio technologies play an important role in access of sorghum technologies.

Inpatient and outpatient health care utilization and expenditures among older adults aged 50 years and above in India

Background: Social and economic inequality in utilization of health care services, as well as high out of pocket expenditures are prevalent in overall Indian population. The situation among older adults will be much more critical as they require long-term health care services. The objective of this study is to assess the utilization of outpatient and inpatient care among older adults and incurred out of pocket health expenditure. It also tried to explore the association between socioeconomic factors on receiving health care services and out of pocket health expenditure among older adults in India.Data source: The data from the Study on Global Ageing and Adult Health (SAGE) Wave 1 was used, which was conducted in 2007-08 in India. Respondents aged 50 and above are taken as older adult population. The final sample size was 7150 respondents aged 50 years and above.Results: The percentage of older adults aged 50 years and above receiving outpatient and inpatient health care service were 87.5% and 14.6% respectively. The use of private health facilities was high compared to government health facility. High utilization of outpatient among women and high use of inpatient care among men were found, which was insignificant after adjusting for other variables. Socioeconomic characteristics also play an important role in access to health care among older adults. Place of residence, marital status, caste, education and presence of morbidity were related to the utilization of health care services. Place of residence, education and wealth quintile were also significantly associated with health expenditures.Conclusion: Requirement of long-term health care among older adult population may result in increasing burden of health care expenditures. Socioeconomic characteristics also play an important role in access to health care among older adults. Developing quality and affordable health care services for older adults to ensure equity in accessibility and affordablility will be a major task for the public health system in India.

Perception of local experts about accessibility to international climate funds: Case of Bangladesh

Adequate financial resources are crucial for mitigation and adaptation interventions. Compared to earlier situation, climate funds now are more organized with diverse sources and mechanisms. However in many cases, the proportion of disbursed amount is very low compared to pledged volume. Deficiency in pecuniary resources is common to climate vulnerable developing countries. Though, on an average, around USD one billion a day flows globally targeting climate change, climate vulnerable country like Bangladesh needs some preparations to access these resources. This study aims at analyzing perceptions of local experts about accessibility of Bangladesh to international climate funds. The other purpose of the study is to assess, based on experts’ evaluation, the level of national preparedness. A set of academics and researchers, development practitioners and government officials has been interviewed using a semi-structured questionnaire. Experts’ evaluations and opinions have been analyzed to determine the criteria imperative to ensure better access to dedicated international climate funds. Unless Bangladesh and also other climate vulnerable developing countries are able to access international funds, optimal level of adaptation and mitigation action is improbable. It would become difficult to access international funds by showing only the vulnerability of the country towards climate change. Higher level of vulnerability may make the donors sympathetic, but not enough to compete for international funds. Beside, preparations of various vulnerability indices do not follow a global political process; hence, vulnerability-based allocation is unlikely. Donors’ preference and the skills of the key personnel or negotiator also play important role in accessibility to climate funds. Different categories of experts have distinct observations. Nevertheless, findings suggest that Bangladesh needs to improve, among others, fund utilization capacity, transparency in allocation as well as monitoring and evaluation system for current and forthcoming climate funds. International flow of climate fund does not show any regular pattern of allocation where highly vulnerable countries are getting higher volume; rather the better-prepared countries are enjoying higher shares from international sources. Bangladesh needs to show its requirement; the capacity it has; transparent mechanisms it follows and feasibility of the proposed program and project to ensure better access to international climate fund. It is also proposed that approaching in a group would enhance the possibility to access higher volume of funds. National level policies need to address the issues to strengthen the national capacity and thereby develop a trend to become competitive. Countries having varied volume of international climate fund can be compared further to investigate the level of readiness and its impact on accessibility to international funds.

Barriers in household access to medicines for chronic conditions in three Latin American countries

BackgroundAccess to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries.MethodsThis was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported.ResultsA chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 – 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector.ConclusionsThe nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.

Do Blood Pressure Levels and Other Patient Characteristics Influence Native Fistula Patency?

Arteriovenous fistulas (AVFs) play an important role in access for hemodialysis, yet premature thrombosis is a challenge. This study identifies factors influencing primary patency in a series of AVF creations. Postoperative systolic blood pressure (BP) was of principal interest; demographical information, comorbidities, smoking status, warfarin, aspirin, clopidogrel, and statins were considered. A retrospective review of AVF creations performed by one surgeon between January 2008 and September 2010 was conducted. Fistula patency was denoted by a bruit and measured at 3 weeks and 12 months after surgery. One hundred and fifty-one AVF creations were studied; 134 fistulas (88.7%) were patent at 3 weeks and 85 (56.3%) at 12 months. The odds ratio (OR) for thrombosis at 12 months was 0.16 (95% CI: 0.04, 0.62; p = 0.008) among patients with a postoperative systolic BP of 120-139 mmHg compared with those with a BP of ≤ 119 mmHg. Patients taking warfarin yielded an OR of 5.71 at 3 weeks (95% CI: 1.20, 27.11; p = 0.028), and 3.33 at 12 months (95% CI: 1.01, 10.99; p = 0.048). No other variables were statistically significant. Patients with postoperative systolic BP of 120-139 mmHg showed a reduction in fistula thromboses compared with patients with a systolic BP of ≤ 119 mmHg. Patients on warfarin were less likely to maintain a patent fistula.

Policies for Seed and Early Stage Finance

This report highlights the growth in support for financial instruments for seed and early stage firms across OECD member countries. These instruments include grants, loans and guarantee schemes, tax incentives and equity funds. This increased support is linked to the recent financial crisis and the growing concern about young firms’ access to finance. The paper notes that framework conditions play an important role in access to finance and must be taken into consideration as a significant part of the policy mix. Demand-side policies to develop entrepreneurial and investment talent and networks are also critical. The role of evaluation and the need to better link policy objectives and outcomes are also discussed.

Geographic disparities in access to cancer care: do patients in outlying areas talk about their access problems to their general practitioners and medical oncologists and how does that impact on the choice of chemotherapy?

Geographic disparities in access to cancer care have been reported for several countries. The distance between the place of residence and the cancer care centre can be one cause of these disparities. Solutions to surmount the barriers can be found if patients talk about this to their care professionals. We investigated whether patients in Valais talk with their physicians about difficulties to access cancer care. We interviewed five general practitioners and five medical oncologists in Valais with semi-structured interviews to identify difficulties patients are talking about. Medical oncologists were also interviewed on their habits to adapt chemotherapy to access problems of their patients. Cancer patients in Valais do talk about their access problems. Medical oncologists in Valais do take access problems into account when discussing therapeutic options with the patients and use the scope they have within their therapeutic options. In Valais the family of cancer patients play an important role in access to cancer care. Special offers are in place when social support is insufficient. Whether some socio-economic minorities do not use the solutions in place cannot be answered and should be investigated in further studies.

Gender and Pensions: An Analysis of Factors Affecting Women's Private Pension Scheme Membership in the United Kingdom

There has been considerable debate about the future sustainability of pension provision and, in particular, the precarious position of many female pensioners. The reasons for women's lower participation rates in private pensions than men's require greater investigation. Using the General Lifestyle Survey (GLF) 2008, this article examines the impact of various characteristics on the likelihood of contributing to a private pension, such as educational attainments, income, occupational group, full-time/part-time status, and whether an individual has any dependent children. It shows that these characteristics play an important role in access to private pensions. Finally, it suggests that strategies to alleviate disadvantages must take into account the complex circumstances that individuals experience throughout the life course, which result in gendered pension provision.

Parents’ experience of seeking help for children with mental health problems

Parents play an important role in access to mental health care for children and adolescents. They are often the first to seek professional help, yet their help-seeking experiences are not well documented. This study investigates parents’ help-seeking for children and adolescents with emotional and behavioural problems. A thematic analysis of interviews with 15 parents showed three main themes describing the help-seeking experience: Pathways to mental health care; intra- and inter-personal infl uences; and the impact of service use experiences. Overall, parents needed to persist through an often arduous process to obtain appropriate mental health care for their children. They often found it difficult to understand the process to obtain help and encountered numerous obstacles. Greater focus on supporting parents in their critical role of identifying mental health problems in their children and gaining early access to appropriate mental health care is needed.