Degree Date
6-2026
Document Type
Dissertation - Public Access
Degree Name
Ph.D. Doctor of Philosophy
Academic Discipline
Community Psychology
First Advisor
Suzette Fromm Reed
Second Advisor
Judah Viola
Third Advisor
Lauretta Ekanem Omale
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.
Recommended Citation
Budowsky, Sara B., "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" (2026). Dissertations. 989.
https://digitalcommons.nl.edu/diss/989
Included in
Child Psychology Commons, Clinical and Medical Social Work Commons, Community Health Commons, Community Psychology Commons, Comparative Psychology Commons, Multicultural Psychology Commons, Psychiatric and Mental Health Commons, Social Justice Commons