So the treatment study focusing on depressed mothers of kids with psychiatric disorders focuses largely on the issue of treatment retention and treatment engagement. So part of the research project has actually been to develop what we call an engagement session, which is based in principles of motivational interviewing and ethnographic interviewing as well to explore barriers to treatment participation. And so in this particular study women are randomized to either receiving this intervention or not, and so for our particular study.

The work is preliminary at this point so I'm not sure I can say, "This is exactly what you have to do," but I will say that really talking to people about what some of the psychological barriers to treatment-seeking might be seems to be an important part of the process. So a lot of times people think it's just the practical issues so mostly when people think about barriers to treatment-seeking they think it's because I don't have a car. It's because I don't have child care. It's because it costs too much, and that's sort of what people think are going to be the major barriers to getting into treatment, but as it turns out there are a lotta psychological issues as well.

For instance they've had negative experiences with healthcare providers in the past or they're really worried about the stigma associated with mental healthcare or there is a mismatch between their ethnicity and the ethnicity of the healthcare provider or they feel like, in the case of the moms that we're seeing, that somebody's going to blame them for their child's psychiatric illness and that people are making them feel guilty and bad about their kid's illness. So I guess the take-home message at least for this population is that there are a lot of psychological issues that maybe supersede even the practical ones and so not to ignore the practical issues that really do play an important role I think for many people in getting in for treatment. I think there are a lot of psychological barriers as well.