Table 3.

Categorization of barriers and facilitators^* for mental health service use among racial/ethnic minority youth by the Social Ecological Model (N = 32 studies).

Adolescent-related factors(n = 21 studies)	Parent-related factors (n = 10 studies)	Therapeutic/service provider-related factors (n = 9 studies)	Contextual/structural factors (n = 15 studies)	Social/cultural factors (n = 9 studies)
Barriers: Disorder type: Externalizing or behavioral problems (48)Internalizing problems (41, 46)Gender: Female (35)Male (31, 55)Adolescent self-perceived barriers or stigma to care (27, 36) Ethnic identity (53) Older age (45)	Barriers: Parent perceived barriers and fear (50, 51) Parenting issues: Parent reliance on discipline (50) Caregiver attachment (53) Lower education level (39, 50) Older age (39)	Barriers: N/A	Barriers: Income: Low income for adequate treatment (29); Low income for emergency services (48); Low income in urban region (47); Low income for inpatient services (49) Insurance type: Medicaid for adequate treatment (29); Having no insurance (29, 47); Having other insurance (47) Family structure: Two-parent household (31); No. of female headed household in the neighborhood (29) Geographic location: Blacks and Hispanics in urban region (47); Blacks in rural region (13); Hispanics in rural region (47); Living in urban Midwest region (47); Living in rural Midwest or south region (47) % of Asians in school (31)	Barriers: Acculturation: High acculturation families (34); High parental affinity to an alternative culture among Latinos and Asian Americans (33); Mid-range cultural pride reinforcement of parents (30)Negative social relationship (36) Parent perceived racial discrimination/prejudice (54)
Facilitators: Diagnosis status/symptom severity (13, 25, 26, 28, 31–33, 35, 37, 40, 44, 47, 48, 53, 54) Disorder type: Externalizing problems/ disorder: (26, 28, 31, 35, 41, 45, 46, 48, 53)Internalizing problems/disorders (28, 45)Gender: Female (25, 31, 39–42, 45)Male (13, 28, 47)Suicidality (27, 38, 48) Older age (40, 42, 47) Internal assets (31) Poor self-rated health (37) Being in foster care (38)	Facilitators: Parent perceived need and etiologic beliefs: Parent-youth concordance on perceived need for mental health services (52); Not parent's idea for treatment (39); Parental concern about the child's behavior, emotional state, or ability to learn (35); Parent beliefs of physical causes, relational issues, and trauma (54) Family stressors or parental strains: Caregiver strain (39); Family stressful life events (25); Parental hassles (30) Parent health: Poor parental health (47); Parents without health problems (39) Extended family caring (30) Female gender (39)	Facilitators: Patient/clinician ethnic match (50, 51) Positive relationship or connection with health providers (36, 43) Therapeutic attributes (e.g., inpatient disposition after visit, arrival at emergency services) (43, 48) Prior receipt of intervention/services/ hospitalization (28, 44) Youth-therapist co-endorsement of etiological beliefs (55) Professional referral by primary care providers, pediatricians, school psychologists, or counselors for home screening (32)	Facilitators: Insurance: Having health insurance (45); Public insurance (e.g., Medicaid) for emergency services (29, 38) or counseling (47) Private insurance for school-based services (39) or emergency services (48) No insurance for emergency services (38, 40) Higher household income (33, 42, 54, 55) Low SES: Low income for school-based services (39); Parent unemployment for school-based services (39); Worse subjective socioeconomic status (37) Family structure: single parent household (13, 47, 49) Blacks and Whites living in urban area (27) Enabling resources such as family/work schedule, availability of childcare, transportation (32)	Facilitators: Difficulty or negative school experiences (Racial discrimination by school adults and peers, Lower sense of agency in school, being expelled or suspended, etc.) (25, 26, 31, 35, 38) Adolescent perceived social support network (28) School assets (31) Teacher referrals or teacher reported need for service (28, 36) Mid-range spiritual/religious coping (30)

^*p < 0.05.