Table 2.

Barriers and Facilitators to Accessing Mental Health Care and Cancer Screening in the Bronx

Levela	Barriers	Facilitators
Public policy regulation and laws	Poverty, mental health reimbursement rates and insurance policies limiting access to care, immigration policy, inconsistent funding priorities	Government funding at the federal, state and local levels for initiatives aimed at reducing health disparities, such as federally qualified health centers, and the New York State Cancer Services Program, the New York City public hospital system; insurance company efforts to enroll patients
Community	Lack of providers, lack of referral sites, limited transportation, distance to clinics	Efforts of community-based organizations to provide accessible, high-quality services and information about and links to healthcare; programs by advocacy organizations and patient navigators to educate about cancer and benefits of screening
Organizational and Institutional	Waiting lists, clinic hours, high caseloads, poor continuity of care	Well-trained frontline social service and medical staff medical provider support to patients, partnerships between hospitals and community-based organizations, integrated models of medical care that include both mental health and preventive care, integration of mental health services into other kinds of social service programs
Interpersonal	Stigma, competing family priorities, interpersonal violence, medical mistrust	Existing social networks, trust of social service agencies
Individual	Lack of insurance and other insurance barriers, competing priorities and responsibilities, work schedule, lack of mental health awareness, low prioritization of self-care, language barriers	Motivation to be a better and healthier parent, interaction with the legal system

^athese categories are based on the social ecological model.