(PS6-67) Access to Behavioral Parent Training for Parents of Children with ADHD: A Simulated Patient Approach

Attention-deficit/ hyperactivity disorder (ADHD) is one of the most common presenting problems for children seeking services (National Survey of Children’s Health, 2019). Yet, parents of children with ADHD and other disruptive behavioral disorders face a limited range of choices in evidence-based treatment. Further, there are large disparities in access to mental health care, with differences in insurance coverage and urbanicity of communities being among the more well-reported barriers to care (Bisgaier & Rhodes, 2011; Evans et al., 2018, Huang et al., 2003; Schatz et al., 2020; Skinner & Mayer, 2007; Syed et al., 2013; van den Hoofdakker et al., 2007). Behavioral Parent Training (BPT) is one of few evidence-based psychosocial interventions to improve behaviors related to ADHD (Evans et al., 2018, Huang et al., 2003; Schatz et al., 2020; van den Hoofdakker et al., 2007). This study evaluated access to BPT for parents of youth with ADHD through the simulated patient approach. Access was measured by 1) availability of a BPT appointment and 2) wait times to first available appointment. In this approach, confederate parents were trained to follow a standardized script to schedule appointments with mental health clinics. They posed as mothers seeking BPT to manage their children’s ADHD symptoms. Through the simulated patient approach, we were able to document  the barriers parents face when attempting to access BPT and other mental health services. A stratified random sample (N=90) of outpatient mental health clinics licensed to serve children and adolescents in New York was identified. These clinics were stratified according to region and urbanicity (metropolitan vs non-metropolitan county). Clinics were then randomly assigned to an insurance condition (private or public insurance). Clinics were contacted at four time points from summer 2021 to spring 2022 (summer, fall, winter, and spring) to assess how seasonality affects access. Data on availability of BPT and wait times to the first available appointment were collected. Further, whether a clinic could be contacted to discuss scheduling an appointment at all was measured. Of the 360 attempts across 4 time points, callers were able to discuss scheduling an appointment 138 times (38%) and were able to make 42 BPT appointments (12%). Wait times ranged from 6 to 77 days (M = 27.73, SD = 21.29). The relationship between urbanicity, insurance coverage, and seasonality with BPT appointment availability was measured using a Chi-Square analysis. Insurance and seasonality were not found to be statistically significant with BPT appointment availability. Analysis indicated that urbanicity was significantly associated with appointment availability [X² (1, N=360) = 6.90, p = .01.]. This indicated that BPT tended to be more available at clinics in metropolitan areas than in non-metropolitan areas. Further analysis of the relationship between urbanicity, insurance coverage, and seasonality with wait times is forthcoming.