Likelihood Of Service Use Research Articles

What are the barriers and facilitators for health and social care professionals accessing organizational wellbeing support services? A mixed-methods study

Recent years have seen increases in workers’ stress levels and sickness absence rates. Organizations have increased the number of wellbeing support services they offer employees, but uptake has been poor. This study investigated barriers and facilitators to accessing organizational wellbeing support services. A two-study, mixed-methods design in health and social care employees was used. Study 1 conducted a directed content analysis of qualitative interview data based on the Theoretical Domains Framework (TDF) to identify barriers and facilitators. These were translated into survey items. Study 2 conducted a quantitative cross-sectional survey to assess whether the number of barriers and facilitators was associated with the likelihood of service use. Study 1 (n = 20) created a survey list of 23 barriers and 23 facilitators. Study 2 (n = 162) found that a greater number of facilitators was associated with a greater likelihood of service access, but number of barriers was not. We concluded that increasing facilitators may increase employee uptake of wellbeing support services. Facilitators include making access routes to services simple and efficient and circulating regular information to staff about available services.

Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study.

BackgroundEmerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area.ObjectiveThis study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline’s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline’s crisis support services if technology and automation were implemented in the future.MethodsA mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline’s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives.ResultsOne-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline’s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services.ConclusionsAlthough Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue.

Use of scheduled and unscheduled health services by cancer survivors and their caregivers.

The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers. English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables. Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other. These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers.

Influence of stigma, sociodemographic and clinical characteristics on mental health-related service use and associated costs among young people in the United Kingdom

This study examined the influence of stigma, psychopathology, and sociodemographic characteristics on mental health-related service use and costs related to service use in a cohort of young people in the UK. Using data from a community sample of young people aged 9–17 years and their caregivers, we assessed 407 young people’s use of services due to mental health problems, young people’s psychopathology, demographic characteristics, maternal education and caregivers’ stigma-related beliefs. Unit costs related to services were gathered from national annual compendia and other widely used sources. We assessed predictors of service use through logistic regression analysis and developed generalised linear models to identify factors associated with costs of mental health-related service utilisation. Persistent psychopathology, socioeconomic disadvantage, and low caregiver intended stigma-related behaviour were associated with increased likelihood of service use among young people. Older age and socioeconomic disadvantage were associated with increased costs. Different factors influenced contact with services and the cost associated with their use — persistent psychopathology and socioeconomic disadvantage increased, and caregivers’ intended stigma-related behaviour decreased the likelihood of using services, whereas socioeconomic disadvantage and older age were associated with increased costs. Social determinants of mental health problems play an important role in the use and costs of different types of mental health-related services for young people. Discordance between drivers of service use and costs implies that young people who are more likely to access services due to mental health problems do not necessarily receive care at the intensity they need.

Influences of Family Relational Factors and Immigration Generation Status on Mental Health Service Utilization Among Asian Americans

Drawing on data from the National Latino and Asian American Study, this article examines the influence of family relational factors, independently and jointly with immigration generation status, on past-year mental health service utilization among Asian Americans ( N = 1,599). Findings revealed the important role of family relation in influencing the likelihood and type of Asian Americans’ mental health service use. Lower level of family cohesion and higher level of family conflict were associated with increased likelihood of service use. Results from multiple logistic regressions further indicated that generation status interacts with family relation in affecting service use. Specifically, effect of family cohesion on general health service use was modified by generation status among third- or later-generation Asian Americans. Practice implications and future research directions are discussed to better understand and address the mental health needs of this population.

Correlates of Formal Support Service Use among Dementia Caregivers

ABSTRACT Informal caregivers for persons with dementia frequently report needing assistance, yet formal support service use has been low. To better understand factors associated with service use, correlates of self-reported service use (e.g., support groups, family mediation, family leave, classes/trainings, and respite care) among dementia caregivers were assessed. The National Poll on Healthy Aging conducted a nationally representative web-based survey of adults aged 50–80 (N = 2,131) using Ispos’ KnowledgePanel®; 148 reported caregiving for an adult with memory loss [61.5% female; 25% nonwhite, 54.1% aged 50–64]. Multivariable logistic regression analyzes assessed caregiver and care recipient characteristics associated with service use within the prior year. Nearly 25% of caregivers used at least one service. Caregiver characteristics associated with greater likelihood of service use included not working [7.5 OR; 2.73, 20.62 CI]; income <$30,000/year [5.9 OR; 1.27, 27.17 CI]; and residing in Western US [7.5 OR; 2.73, 20.62 CI]. Ability of care recipient to be left alone safely for only three hours or less [5.1 OR; 1.66, 15.46 CI] was associated with greater likelihood of use. Support service use remains low. Findings suggest need to consider caregivers’ employment status, income, and geographical location in service design and implementation.

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey.

We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used weighted data (N = 2317) from NCS-A participants (age: 13-18years) who did not meet DSM-IV criteria for any lifetime mental disorder. Adolescent mental disorders were assessed with the WHO CIDI. Maternal psychopathology was obtained by self-report. Adolescent mental health service use was assessed with the Service Assessment for Children and Adolescents. Substantial associations between maternal psychopathology and mental health service use in offspring without mental disorders were found between affective disorders and the mental health/medical specialty (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.60-3.90) and any service sector (HR = 2.14, CI = 1.45-3.16), anxiety disorders and any service sector (HR = 1.63, CI = 1.13-2.35), behavior disorders and the school (HR = 3.69, CI = 1.39-9.77) and any service sector (HR = 2.81, CI = 1.12-7.07), substance use disorders and the mental health/medical specialty (HR = 3.75, CI = 1.75-8.03), the school (HR = 3.17, CI = 1.43-7.02), and any service sector (HR = 3.66, CI = 2.00-6.70), and any mental disorder and the mental health/medical specialty (HR = 2.10, CI = 1.34-3.30) and any service sector (HR = 2.03, CI = 1.40-2.92). Results were comparable when restricting analyses to offspring with no indication of suicidality and no more than three life events during the past 12months. The likelihood of service use was higher among offspring of mothers with mental disorders, compared to mothers without mental disorders. Considering maternal mental disorder status may help to identify subjects at risk of overtreatment.

Use of Drug Treatment Services Among Adults With Opioid Use Disorder: Rates, Patterns, and Correlates.

The study examined rates, patterns, and correlates of drug treatment services use among adults with opioid use disorder compared with adults with other drug use disorders. Data were from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, which surveyed a nationally representative sample of noninstitutionalized U.S. civilian adults. The proportions reporting drug treatment services use were compared between those with opioid use disorder and those with other drug use disorders. Multivariable-adjusted regression analyses identified factors associated with service use. Adults with opioid use disorder (N=330, unweighted) reported a very low rate of any drug-related health services use (17.3%), although the rate was higher than among adults with other drug use disorders (7.4%) (p<0.001). Crisis-related services were the most common type of service used among adults with opioid use disorder (6.2%)-significantly higher than the rate among those with other drug use disorders (0.6%) (p<0.001). Few (3.3%) adults with opioid use disorder used outpatient drug treatment services. Among all adults with drug use disorders, opioid use disorder was associated with greater odds of using drug treatment services (adjusted odds ratio=2.43; 95% confidence interval=1.38-4.28). Living in the West and reporting moderate to extreme pain were associated with a lower likelihood of service use among all adults with drug use disorders (p<0.05 for each). Most adults with opioid use disorder remain untreated, much less received outpatient treatment to address their addiction. Interventions are needed to improve access to and motivation for care among these vulnerable adults.

Factors associated with health service utilisation for common mental disorders: a systematic review

BackgroundThere is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC).MethodsWe searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using “best fit framework synthesis”, with reference to the Andersen socio-behavioural model.ResultsFifty two studies met inclusion criteria. 46 (88%) were from HIC.Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies.Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported.Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services.There was a lack of research from LMIC and on contextual level factors.ConclusionIn HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that “treatment gap” statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors.Trial registrationPROSPERO registration number: 42016046551.

Attitudes about the VA health-care setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF veterans.

In the present study, the authors explored gender differences in attitudinal barriers to and facilitators of care for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans and examined the relationship of those factors with VA mental health service use among female and male veterans with probable mental health conditions. Data were collected as part of a national cross-sectional survey of OEF/OIF veterans; the current sample was limited to participants with a probable diagnosis of posttraumatic stress disorder, depression, or alcohol abuse (N = 278). Although negligible gender differences were observed in attitudes about VA care and perceived fit in the VA setting, men reported slightly more negative beliefs about mental illness and mental health treatment than women. In addition, logistic regressions revealed different associations with VA mental health service use for women and men. For women only, positive perceptions of VA care were associated with increased likelihood of seeking mental health treatment. For men only, perceived similarity to other VA care users and negative beliefs about mental health treatment were associated with increased likelihood of service use, whereas negative beliefs about mental illness were associated with lower likelihood of service use. For both women and men, perceived entitlement to VA care was associated with increased likelihood of service use and negative beliefs about treatment-seeking were associated with a reduced likelihood of seeking mental health care in the past 6 months. Results support the need for tailored outreach to address unique barriers to mental health treatment for female and male OEF/OIF veterans.

How Large Is the Gap Between Self-Report and Assessed Mental Health and Does It Impact Older Adult Mental Health Service Utilization?

We examined the relationship between self-reported and assessed mental health status and service use, using data from the Health and Retirement Study (N = 9,547). Twelve percent and thirty percent had inaccurate perceptions of their mood and memory status, respectively. No significant difference was found in the likelihood of service use between older adults who were unaware of current depressive symptoms and those who self-reported problems but had no assessed symptoms. Older adults who scored low in cognitive test were more likely to use services, regardless of self-reported memory status. Discrepancies between self-reported and assessed status may contribute to service utilization.

Predictors of post-sentence mental health service use in a population cohort of first-time adult offenders in Western Australia.

Little is known about whether or how offenders use mental health services after sentence completion. This study aimed to determine the likelihood of such service use by adult (18-44 years) first-time offenders up to 5 years after sentence completion and possible predictor variables. Pre-sentence and post-sentence mental health service use was obtained from whole-population linked administrative data on 23,661 adult offenders. Cox proportional hazard models were used to determine which socio-demographic, offending and pre-sentence health service variables were associated with such post-sentence service use. The estimated 5-year probability of any post-sentence mental health service use was 12% for offenders who had not previously used such services, but still only 42% for those who had. For the latter, best predictors of post-sentence use were past psychiatric diagnosis and history of self-harm; history of self-harm also predicted post-sentence use among new mental health services users and so also did past physical illness. Indigenous offenders had a greater likelihood of service use for any mental disorder or for substance use disorders than non-Indigenous offenders, irrespective of pre-sentence use. Among those with pre-sentence service contact, imprisoned offenders were less likely to use mental health services after sentence than those under community penalties; in its absence, socio-economic disadvantage and geographic accessibility were associated with greater likelihood of post-sentence use. Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders.

Bridging the Gap Between Common Mental Disorders and Service Use: The Role of Self-Rated Mental Health Among African Americans

The unmet need for mental health care in racial/ethnic minorities has been a major public health concern. Using a sample of African Americans, this study questioned whether self-rated mental health (SRMH), an individual's subjective assessment of personal mental and emotional status, modifies the link between mental disorders and service use. Cross-sectional analyses of the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005-2006. In-home personal interviews. Self-identified African American/black participants aged 40 to 85 years (N = 460). Participants were assessed if they met the diagnostic criteria for three common mental disorders (major depression, generalized anxiety disorder, and panic disorder) in the prior 12 months, using the Composite International Diagnostic Interview (CIDI). Response to a single-item SRMH was dichotomized (excellent/very good/good or fair/poor). Service use was indicated by the use of any services in the past year (mental health specialist, general doctor, and clergy). Multivariate analyses identified a significant interaction between mental disorder and SRMH in predicting service use. The likelihood of service use increased substantially when individuals with a disorder reported their mental health to be fair/poor. Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors. Findings suggest that interventions that enhance an individual's self-awareness of mental health problems may help bridge the gap between mental health care needs and service use in African Americans.

Geographical Access and the Substitution of Traditional Healing for Biomedical Services in 2 American Indian Tribes

American Indians who live in rural reservation communities face substantial geographic barriers to care that may limit their use of health services and contribute to their well-documented health disparities. The purpose of this study was to examine the impact of geographical access to care on the use of services for physical and mental health problems and to explore American Indians' use of traditional healing services in relation to use of biomedical services. We analyzed survey data collected from 2 tribes (Southwest and Northern Plains). Geographical access to the closest biomedical service was measured using a Geographic Information System, including road travel distance, elevation gain, and reservation boundary crossing. Use of biomedical services was unaffected by geographical access for Northern Plains tribal members with mental health problems and for Southwest tribal members with physical or mental health problems. For members of the Northern Plains tribe with physical health problems, travel distance (P=0.007) and elevation gain (P=0.029) significantly predicted a lower likelihood of service use. The use of traditional healing was unrelated to biomedical service use for members of the Northern Plains tribe with physical or mental health problems and for members of the Southwest tribe with physical health problems. For members of the Southwest tribe with mental health problems, the use of biomedical services increased the likelihood of using traditional healing services. Findings suggest that biomedical services are geographically accessible to most tribal members and that tribal members are not substituting traditional healing for biomedical treatments because of poor geographical access.

Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity--Implications for Diagnosis and Ultra-High Risk Research

It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n = 3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89-2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006-.0244), cannabis use (P < .0009), and any drug use (P < .0008). Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.

Use of Primary and Specialized Mental Health Care for a Major Depressive Episode in Spain by ESEMeD Respondents

This study described use of services for a major depressive episode and determined factors associated with use in Spain, a country with universal access to care and a relatively low prevalence of depression. Data were from the European Study of the Epidemiology of Mental Disorders (ESEMeD). ESEMeD-Spain was a cross-sectional, general population survey conducted with a representative sample of noninstitutionalized adults (N=5,473). The Composite International Diagnostic Interview was used, and 12-month use of services for a major depressive episode, types of services used, and receipt of minimally adequate treatment were assessed. Among the 247 respondents with a major depressive episode in the past 12 months, 59% reported any use of past-year services for their disorder; of this group, 76% reported receipt of any active treatment (from a health care or mental health professional). Among respondents with severe depression, 31% used no services. A higher likelihood of service use was found among those who were unemployed or too disabled to work (OR=4.9, CI=1.3-19), who had moderate depression symptoms (OR=3.2, CI=1.1-9.0), and who had one mental disorder comorbid with depression (OR=2.9, CI=1.2-7.0) or two or more such comorbid disorders (OR=4.1, CI=1.9-8.9). In the active treatment group, only 31.2% received treatment that was minimally adequate. There is a need in Spain to increase use of services for a major depressive episode, especially among certain population groups, such as women, and to improve adequacy of treatments. The role of specific factors, such as availability of services and of professionals, deserves further research.

Use of Primary and Specialized Mental Health Care for a Major Depressive Episode in Spain by ESEMeD Respondents

Objective: This study described use of services for a major depressive episode and determined factors associated with use in Spain, a country with universal access to care and a relatively low prevalence of depression. Methods: Data were from the European Study of the Epidemiology of Mental Disorders (ESEMeD). ESEMeD-Spain was a cross-sectional, general population survey conducted with a representative sample of noninstitutionalized adults (N=5,473). The Composite International Diagnostic Interview was used, and 12-month use of services for a major depressive episode, types of services used, and receipt of minimally adequate treatment were assessed. Results: Among the 247 respondents with a major depressive episode in the past 12 months, 59% reported any use of past-year services for their disorder; of this group, 76% reported receipt of any active treatment (from a health care or mental health professional). Among respondents with severe depression, 31% used no services. A higher likelihood of service use was found among those who were unemployed or too disabled to work (OR=4.9, CI=1.3–19), who had moderate depression symptoms (OR=3.2, CI=1.1–9.0), and who had one mental disorder comorbid with depression (OR=2.9, CI=1.2–7.0) or two or more such comorbid disorders (OR=4.1, CI=1.9–8.9). In the active treatment group, only 31.2% received treatment that was minimally adequate. Conclusions: There is a need in Spain to increase use of services for a major depressive episode, especially among certain population groups, such as women, and to improve adequacy of treatments. The role of specific factors, such as availability of services and of professionals, deserves further research. (Psychiatric Services 62:152–161, 2011)

Use of Clergy Services among Individuals Seeking Treatment for Alcohol Use Problems

This study examined the prevalence and characteristics of adults with an alcohol use-related problem who receive clergy services. Data come from the National Epidemiologic Survey on Alcohol and Related Conditions. Among persons who sought any services for alcohol-related problems (n = 1,910), 14.7% reported using clergy services. In a multivariable logistic regression model, factors associated with increased likelihood of service use included being Black, aged 35-54 years, a lifetime history of alcohol dependence, major depressive disorder, and personality disorder. Clergy may benefit from training to identify alcohol use problems and serve an important role in making treatment referrals.

Service use and multi-sector use for mental health problems by youth in contact with child welfare

This article uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to examine multi-sector service use for mental health problems by youth in contact with social service agencies. At 18-months post-investigation for abuse/neglect, 24% was receiving some service for a mental health problem. Among served youth, 33% received services from multiple sectors. Likelihood of service use was higher for youth who were older, male, in non-kin foster care, had more severe mental health problems, and more parental risk factors. Among service users, few factors differentiated youth who used multiple sectors from those served in only one sector.

Behavioral Predictors of Mental Health Service Utilization in Childhood Through Adolescence

This study investigated predictors of mental health service utilization from age 5 through age 16. Data were collected on a community sample of 399 children, including 338 European Americans and 61 African Americans. Internalizing and externalizing behaviors were assessed by maternal and teacher reports in kindergarten. History of mental health service utilization was assessed by maternal reports when participants were 16 years old. On average, the probability of first-time mental health service utilization increased in early to middle childhood, stabilized, and then increased in early adolescence. Mother reports of internalizing behaviors (independent of teacher reports of externalizing behaviors) predicted an increased likelihood of service use among European American children but a decreased likelihood of service use among African American children. Externalizing behaviors (independent of internalizing behaviors) predicted a higher likelihood of first-time service use in middle childhood. The combination of elevated internalizing and externalizing behaviors predicted a higher likelihood of first-time service use in adolescence, mainly among European American children. This study provides evidence that elevated mother-reported internalizing behaviors are less likely to forecast mental health service utilization among African American children compared with European American children. To meet the mental health service needs of all children, it is critical to further examine reasons for service utilization and underutilization among children with internalizing problems.