Low-income and ethnic minority youth experience high psychiatric need but persistently low participation in traditional mental health care. General pediatricians are often the first and only healthcare providers with whom many families engage around their child’s emotional and behavioral development. Using both quantitative analysis of retrospective secondary data and Interpretative Phenomenological Analysis (IPA) of in-depth interviews with diverse caregivers, this project explored influencers of child mental health and family utilization of pediatric primary-care-based mental health services in the context of a uniquely multicultural clinic serving a predominantly Medicaid population. Three key findings include: 1) Caregiver Stress was a highly significant, moderate predictor of reported child mental health symptoms, which in turn was moderately predicted by Perceived Financial Strain. 2) The primary care setting had the potential to reduce or increase caregiver stress depending on the relational and power dynamics between providers and families, and the ability of the setting to address concrete needs. 3) Caregivers’ openness to and comfort with child behavioral health interventions in the primary care setting was influenced by the experience of trust, genuine caring, horizontal partnership, and perceptions of providers’ understanding and openness to their values, beliefs, and lived experiences. IPA findings suggested important differences between the experiences of African American families and other ethnic minority groups, with the experience of racism and bias in healthcare having a particularly profound impact on this group. Overall, findings suggest that, for ethnic minority families with Medicaid, the primary care setting may serve as either a force that oppresses or a community that uplifts.
","abstract_html":"<p>Low-income and ethnic minority youth experience high psychiatric need but persistently low participation in traditional mental health care. General pediatricians are often the first and only healthcare providers with whom many families engage around their child’s emotional and behavioral development. Using both quantitative analysis of retrospective secondary data and Interpretative Phenomenological Analysis (IPA) of in-depth interviews with diverse caregivers, this project explored influencers of child mental health and family utilization of pediatric primary-care-based mental health services in the context of a uniquely multicultural clinic serving a predominantly Medicaid population. Three key findings include: 1) Caregiver Stress was a highly significant, moderate predictor of reported child mental health symptoms, which in turn was moderately predicted by Perceived Financial Strain. 2) The primary care setting had the potential to reduce or increase caregiver stress depending on the relational and power dynamics between providers and families, and the ability of the setting to address concrete needs. 3) Caregivers’ openness to and comfort with child behavioral health interventions in the primary care setting was influenced by the experience of trust, genuine caring, horizontal partnership, and perceptions of providers’ understanding and openness to their values, beliefs, and lived experiences. IPA findings suggested important differences between the experiences of African American families and other ethnic minority groups, with the experience of racism and bias in healthcare having a particularly profound impact on this group. Overall, findings suggest that, for ethnic minority families with Medicaid, the primary care setting may serve as either a force that oppresses or a community that uplifts.</p>","abstract_has_math":false,"creators":["Budowsky, Sara B."],"institution":null,"degree_name":"Ph.D. Doctor of Philosophy","degree_level":"Dissertation - Public Access","degree_discipline":"Community Psychology","degree_department":null,"school":null,"contributors":["Suzette Fromm Reed","Judah Viola","Lauretta Ekanem Omale"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-06-01T07:00:00Z","date_published":"2026-06-01T07:00:00Z","updated_at":"2026-07-24T03:21:46Z","subjects":["interpretative phenomenological analysis","collaborative care","integrated care","primary care","mental health disparities","cultural attunement","Child Psychology","Clinical and Medical Social Work","Community Health","Community Psychology","Comparative Psychology","Multicultural Psychology","Psychiatric and Mental Health","Social Justice"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digitalcommons.nl.edu/diss/989","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Suzette Fromm Reed","Judah Viola","Lauretta Ekanem Omale"]},{"key":"dc:creator","label":"Author","values":["Budowsky, Sara B."]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2026-05-30T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Community Psychology"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation - Public Access"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Ph.D. Doctor of Philosophy"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["interpretative phenomenological analysis","collaborative care","integrated care","primary care","mental health disparities","cultural attunement","Child Psychology","Clinical and Medical Social Work","Community Health","Community Psychology","Comparative Psychology","Multicultural Psychology","Psychiatric and Mental Health","Social Justice"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://digitalcommons.nl.edu/diss/989"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Low-income and ethnic minority youth experience high psychiatric need but persistently low participation in traditional mental health care. General pediatricians are often the first and only healthcare providers with whom many families engage around their child’s emotional and behavioral development. Using both quantitative analysis of retrospective secondary data and Interpretative Phenomenological Analysis (IPA) of in-depth interviews with diverse caregivers, this project explored influencers of child mental health and family utilization of pediatric primary-care-based mental health services in the context of a uniquely multicultural clinic serving a predominantly Medicaid population. Three key findings include: 1) Caregiver Stress was a highly significant, moderate predictor of reported child mental health symptoms, which in turn was moderately predicted by Perceived Financial Strain. 2) The primary care setting had the potential to reduce or increase caregiver stress depending on the relational and power dynamics between providers and families, and the ability of the setting to address concrete needs. 3) Caregivers’ openness to and comfort with child behavioral health interventions in the primary care setting was influenced by the experience of trust, genuine caring, horizontal partnership, and perceptions of providers’ understanding and openness to their values, beliefs, and lived experiences. IPA findings suggested important differences between the experiences of African American families and other ethnic minority groups, with the experience of racism and bias in healthcare having a particularly profound impact on this group. Overall, findings suggest that, for ethnic minority families with Medicaid, the primary care setting may serve as either a force that oppresses or a community that uplifts.
"]},{"key":"dc:title","label":"Title","values":["Diverse Families Navigating Mental Health at the Pediatrician’s Office: A Mixed Methods Exploration of the Interplay of Stress, Culture, and Child Mental Health in the Primary Care Setting"]}]}],"canonical_facts":{"dc:contributor":["Suzette Fromm Reed","Judah Viola","Lauretta Ekanem Omale"],"dc:creator":["Budowsky, Sara B."],"dc:date.available":["2026-05-30T07:00:00Z"],"dc:description.abstract":["Low-income and ethnic minority youth experience high psychiatric need but persistently low participation in traditional mental health care. General pediatricians are often the first and only healthcare providers with whom many families engage around their child’s emotional and behavioral development. Using both quantitative analysis of retrospective secondary data and Interpretative Phenomenological Analysis (IPA) of in-depth interviews with diverse caregivers, this project explored influencers of child mental health and family utilization of pediatric primary-care-based mental health services in the context of a uniquely multicultural clinic serving a predominantly Medicaid population. Three key findings include: 1) Caregiver Stress was a highly significant, moderate predictor of reported child mental health symptoms, which in turn was moderately predicted by Perceived Financial Strain. 2) The primary care setting had the potential to reduce or increase caregiver stress depending on the relational and power dynamics between providers and families, and the ability of the setting to address concrete needs. 3) Caregivers’ openness to and comfort with child behavioral health interventions in the primary care setting was influenced by the experience of trust, genuine caring, horizontal partnership, and perceptions of providers’ understanding and openness to their values, beliefs, and lived experiences. IPA findings suggested important differences between the experiences of African American families and other ethnic minority groups, with the experience of racism and bias in healthcare having a particularly profound impact on this group. Overall, findings suggest that, for ethnic minority families with Medicaid, the primary care setting may serve as either a force that oppresses or a community that uplifts.
"],"dc:identifier":["https://digitalcommons.nl.edu/diss/989"],"dc:subject":["interpretative phenomenological analysis","collaborative care","integrated care","primary care","mental health disparities","cultural attunement","Child Psychology","Clinical and Medical Social Work","Community Health","Community Psychology","Comparative Psychology","Multicultural Psychology","Psychiatric and Mental Health","Social Justice"],"dc:title":["Diverse Families Navigating Mental Health at the Pediatrician’s Office: A Mixed Methods Exploration of the Interplay of Stress, Culture, and Child Mental Health in the Primary Care Setting"],"thesis:degree_discipline":["Community Psychology"],"thesis:degree_level":["Dissertation - Public Access"],"thesis:degree_name":["Ph.D. Doctor of Philosophy"]},"updated_at":"2026-07-24T03:21:46Z"}