"Fighting Tooth and Nail": Barriers to Accessing Adolescent Mental Health Treatment from Mothers Perspectives.

Residential treatment (RT) serves 311,000 children and adolescents per year and has been described as a "last resort" by families, healthcare providers, and insurance payors as it is highly disruptive and costly. The purpose of this study was to explore mothers' accounts of the strategies and services they used before admitting their adolescent to RT as well as to understand the barriers they encountered in their adolescent's treatment trajectory. This was a cross-sectional study in which 15 mothers of adolescents currently or previously in RT completed 1-h phone interviews. Data were analyzed using content analysis generating two themes and seven subthemes. The first theme, 'the lead up to residential treatment,' consists of descriptions of the treatment modalities before RT and mothers' initial impressions of RT. The second theme, "fighting tooth and nail," consists of descriptions of mothers' actions to get their adolescent the mental health services they needed as well as the barriers they navigated along the way. While their adolescents were serious threats to themselves and others, mothers reported encountering significant obstacles to accessing RT, including substantial societal and financial barriers. While there is no shortage of evidence-based practices available that are effective in reducing disruptive behaviors in children, there are still macro-level implementation barriers that families are navigating to access mental health treatment for their child.