DRAFT PROSPECTUS

Submitted by:

James Dada

April 14, 2020

Hello James, I suggest below that you contact either the organizations and the clinics to find out if either of them will help you get participants and how. If they won’t you can’t do your study and it would be better to know that right now. OR you can look at facebook groups of therapists and psychologists. Then you can do a national sample. During COVID this is becoming popular and is an effective way.

You also still need to read and write about methods. See the suggested articles in the comment here on this page.

You also need to read some articles about qualitative research and qualitative descriptive research and write more in that section. OH—and remember to put the ISP I created for you in LoudCloud and when you are done with these revisions put them in the first dropbox for prospectus. I reassigned them both.

Wishing you wellness, Dr. Seymour

The Prospectus Overview and Instructions

Dissertation Prospectus

Introduction

Kohn et al. (2018) noted that in the United States (US), there is the existence of a gap between mental health patients that require treatment and those that successfully receive the treatment. Overall, there is a need to identify the social determinants of mental disorders, align it with its sustainable development goals, and identify potential mechanisms and targets for interventions (Lund, et al. 2018). Specifically, Lund et al., (2018) have expressed a need for further research on the reasons why people decide to utilize or reject mental health services. The mental health patients that seek mental health treatment and medication are fewer than the number of patients suffering. This research study will examine the factors according to mental health providers that influence an individuals' decision to utilize or reject mental health services in South Texas. The mental health providers will be asked for strategies to encourage patients to accept and to not reject treatment at the start of treatment and when continuing treatment. The target population for the study is South Texas, this research is needed to systematically review evidence regarding the potential mechanisms that cause people to utilize or reject mental health treatment. Comment by Dr. Seymour: You deleted this but I think it is important because xxxxx.

These studies have not focused on what Lund et al. (2018) recommended additional research on as specific reasons why people accept or reject mental health treatment. This study adds to the research in that it asks the first line of defense what they have seen and what they believe is needed to support patients’ use of mental health treatment.

There is a need for the research at several levels. The reasons why people choose to utilize or reject treatment lead to a treatment gap. According to Kohn, et al. (2018), there is a gap in mental health treatment in America when examined through the prevalence of mental health disorders and the lack of use of mental health services. For example, while 42.6% of children and adolescents in the US suffered mental illness, the treatment gap in this group was 64%. The use or rejection of mental health services depends upon the collaborative nature of participating in treatment; the patient and the provider work together to make the therapy worthwhile.

Patients have choices and they may choose to reject treatment, not adhere to advice, or reject taking prescriptions. The providers of the mental health treatment are those that experience the different circumstances and will be interviewed in this study to access those lived experiences with patient acceptance or rejection of mental health treatment. This is a need in South Texas, but also across the globe. Indeed, mental health is a major issue around the World. The United Nations (UN, 2015) has identified mental health as one of its Sustainable Development Goals.

Mental health is a national problem as well. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice, millions of people suffer from mental illness in this country. According to the National Alliance on Mental Health (2019), 47.6 million people in the U.S. experienced signs of a mental illness in 2018. This amounts to one in every five adults. Roughly 11.4 million Adults between the ages of 25 and 35 had an episode of serious mental illness that same year. In 2016, 7.7 million young people between the ages of 6 and 17 experienced some sort of mental health disorder, while 9.2 million people were reported to have experienced a substance use disorder (National Alliance on Mental Illness, 2019). The high numbers necessitate raising public awareness and campaigning for a better health care system (Hamilton.et al. 2016). Part of this effort is identifying the reasons why people choose to utilize or reject mental health support.

Mental health is a serious issue in South Texas. There is a high need for this research in South Texas. One reason is because this region receives the second-largest allocation of governmental funds for mental health in the United States (Mista et al., 2017). The large allocation is because there is a documented high need for mental health services in South Texas (Kohn, et al., 2018). This means that there are significant funds available, and therefore greater possibility for people to accept or reject mental health treatment. Texas (2017) asserts that people suffering from mental illness still face problems despite the huge costs that are directed towards healthcare. Understanding why people use or reject this available mental health may help policymakers to successfully market mental health treatment and get people the services they need (Kohn, et al., 2018). Another reason is that mental health services in this southern state have faced several population growths challenges. Schwartz (2017), in support of the Southern State Region, argues that the increased growth-rate of populations in one specific county located in a southern state has impacted the health sector at large. The high population together with economic constrains has led to a decrease in the number of health insurance policies. The access to and utilization of mental health care for the populations living in this county has created a gap within the State (Children at Risk, 2013).

Given the above noted societal needs documented in the world, the nation, and the region of South Texas (Mista et al., 2017), this study will examine the gap: there is a need to understand why people choose to utilize or reject mental health services (Lund, et al., 2018). The successful use of mental health treatment has been called social inclusion. This is also recommended by Hall, Kakuma, Palmer, Minas, Martins, & Kermode, (2019), stated that, promoting social inclusion of people with mental illness is consequently a key goal of human rights and global mental health programming to achieve people-centered mental health care, and interventions to promote social inclusion aim to minimize the impact of attitudinal, structural and behavioral drivers of social exclusion. There is good evidence that supported employment programs for people with mental illness and interventions to reduce mental health stigma (e.g. mental health education, direct contact with people with mental illness) are effective in high income countries (Hall, et al., 2019. p. 20 - 22).

In summary, this section introduced the topic of the factors influencing decisions of seeking or rejecting mental health treatment. Then a summary on the research on the topic was presented including problem of the study. Finally, the societal context for the study was detailed at the global, national, and regional levels demonstrating that the mental health problem is significant and requires intervention.

Background of the Problem

According to the Centers for Disease Control and Prevention (2018), mental health has become a significant public health issue in the United States that requires immediate attention. There is a gap in the research regarding the reasons people utilize or reject mental health treatment (Lund, Hall et al, 2018). Literature indicates that mental health patients tend to terminate treatment plan before the doctor’s specified date and others neglect seeking treatment from healthcare facilities. Tomczyk, (2020), stated that there was concurrent impact of structural and attitudinal factors on help-seeking behavior for mental health problems. Furthermore, (Vega, 1999), stresses that further study in needed to ascertain the extent of underutilization of mental health services and issues among urban and rural Mexican American adults. While Vega, et al. (1999) states that research indicates that only 8.8 percent of the overall of the Mexican-Americans utilize mental health care providers by persons with diagnosed mental disorders, which raises the questions on the appropriateness, accessibility, and cost-effectiveness of mental health care for this population; hence, the need to examine the reasons for low utilization of services in future research (Vega, et al., 1999).

The history of how this problem began dates back to the beginning of mental health services in the US. The U.S. Mental Health Care & Policy known as Mental Health America (MHA) was developed in 1909. The biggest mental health societal problem at the time included, Bipolar Disorder (manic depressive illness), Dementia, and schizophrenia (Mental Health America, 2020). Mandell, (1995) described the origins of mental health and its history as a mental hygiene. The term mental hygiene was first used in the United States by William Sweetzer in 1843 after the civil war when there was increased concern about the effects of unsanitary conditions. There was the vision for a community-based mental hygiene that would operate through education, social culture, religion and involvement in national life. Later research on use of mental health services according to Armbruster (1997) noted that there were those that had the opinion that there should be efforts at bridging the gap between service need and service utilization among the socioeconomically disadvantaged, minority, and the psychiatrically impaired population. According to Lake, (2017), current research on use of mental health services found that current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness that accounts for about one-third of adult disability globally. While Tomczyk, (2020), suggests that to date, little is known in the concurrent impact of structural and attitudinal factors influencing behavior for mental health problems especially for treatment purposes.

Theoretical Foundations/Conceptual Framework and Review of the Literature/Themes

Theoretical literature

The theoretical model for this research gap is Albert Bandura’s Social Cognitive Theory (Morin & Cherry, 2019). According to Morin & Cherry, (2019), the Social Cognitive Theory can be applied to the context of mental health promotion and prevention. It helps to describe how motivations in health and behaviors are influenced by the interaction of people's beliefs, environment, and behaviors (Lake, 2017). It was advocated by famous psychologist Albert Bandura (Morin, 2019). It is important to determine the limiting factors behind individuals and families not currently getting the mental health services and treatment plan.

Major components of the theory concerning individual behavior change include:

• Self-efficacy: refers to the belief and self confidence that an individual can control and execute a behavior successfully in. It is unique and influenced by an individual's specific capabilities and other environmental factors. In terms of mental health use or rejection, self-efficacy is an individual's belief about his or her capabilities to produce designated levels of performance, which may influence over events that impact life. Self-efficacy beliefs tend to regulate how individuals feel, think, motivate themselves and behave. These beliefs lead to diverse effects through four major processes including cognitive, motivational, affective and selection processes (Bandura, 1994).

• Behavioral capability: involves an understanding and the possession of skills and ability to perform behavior. To successfully carryout a task as behavioral skill, an individual is required to know what to do and how to do it. By performing the tasks, individuals will learn from poor performance in their behavior and the consequences thereof.

In terms of mental health use or rejection, behavioral capability is people’s change models including health behaviors and intentions that includes smoking, drinking, health services utilization, and substance use, among others. A mental health person’s behavioral achievement primarily depends on both motivation (intention) and ability (behavioral control). This also involves the extent to which the person has a favorable or unfavorable evaluation of the behavior of interest, which also include the motivational factors that influences behavior. For example, the stronger the intention, the more likely the behavior will be performed. However, social norms such as rejection may impact behavior negatively, this include emotion, cognition and even physical health. Sometimes, behavior become aggressive and can turn to violence (Weir, 2012).

• Expectations: determines the outcomes of behavior change. It is the anticipated consequences of a person's behavior. This can include expectations on health-related or not health-related issues. Some people anticipate consequences from their actions before actually participating in a behavior, and the consequences tend to influence successful completion of the behavior. Expectations are mostly derived from past experiences. In terms of mental health use or rejection, expectations involve personal relevance of an individual’s beliefs that others devalue, discriminate against, and label mental patients. This can lead to self-stigma and self-devaluation in various psychosocial outcomes and quality of life, including self-esteem and general functioning. This is because people often develop the conceptions of what others already perceived about mental patients even before they become patients and what they will feel or think about them now (Picco, et al., 2017).

· Reciprocal Determinism: it refers to the dynamic and reciprocal interaction of individual learned experiences that include environment (external social context), and behavior (responses to stimuli to achieve goals). In terms of mental health use or rejection, a mental health individual’s behavior is controlled and determined the person himself through processes, and by his environment. For example, there is every possibility that an adolescent who dislikes going to school will act out negatively in class; and if his teachers and classmates react to his behavior, it reinforces his dislike for school, which can create a hostile environment (Cherry, 2018).

· Observational learning: refers to observing outcomes of others’ performance or modeled behavior. It explains that people can witness and observe the behaviors of others, and then reproduce those actions. Mostly exhibited by "modeling" of such behaviors. Literarily means that when a person sees a successful demonstration of a habit, they tend to repeat the same behavior successfully. In terms of mental health use or rejection, observational learning help people with mental disorders to observe others and retain information, and later replicate the behaviors that were observed. This play important roles in their socialization process as they observe other caregivers interact and respond among themselves. It helps them to developing a therapeutic relationship, communicating and creating a dialogue, and working to overcome problematic thoughts or behaviors (Cherry, 2018).

· Reinforcements: means promoting incentives and rewards that encourage behavior change. It can be either internal or external responses to an individual's behavior that may likely impact the continuing or discontinuing of the behavior. It may be self-initiated or in the environment and can be either positive or negative. In terms of mental health use or rejection, reinforcements can have positive or negative effects on people with mental health disability. Reward such as praises are offered for showing and expressing good behavior is positive and can influence future good behavior. Religious reinforcement about mental health and the stigma associated with is an obstacle to treatment and is considered negative. In addition, the way the new media treat the issue of mental health in the society encourages societal stigma related to it (Peteet, 2019).

Literature Themes

Review of the literature review identified the following themes:

· Mental Health Infrastructure Comment by Dr. Seymour: I formatted all of this for you.

The mental health infrastructure is the mental health professionals that include psychologists, psychiatrists, counselors, psychiatric nurses and clinical social workers. The healthcare sector has limited number of mental health providers that increases the challenges of combating increasing mental health patients and conditions. In the U.S the access to competent mental health providers is scarce in rural areas making it difficult for treating mental health illness (Prince, 2015). This infrastructure may impact reasons to accept or reject treatment.

· Reasons for Lack of Access to Mental Health

These include lack of insurance according to Kung, (2004) and Kohn, et al., (2018), lack of mental health professionals (Scripps Media, 2020), (Moore, & Krehbiel, 2016) and even poverty (Grayson, 2016). Research has shown that many people due to poor economic status have left many people without health insurance as they cannot afford it. This limits many average and lower-class families from accessing mental illness services (Children at Risk, 2013). Impoverished people may mislabel mental illness as mere signs of hunger and poor diet instead of mental illness (Children at Risk, 2013).

In the United States, 42% of the population believe that cost and poor insurance coverage are the top barriers that prevents them from accessing mental health care. While only 25% reported that they make decisions between using mental health treatment or paying for daily necessities (National Council for Behavioral Health, 2018). Getting face-to-face services remains a top priority for many Americans who are seeking mental health treatment than getting access to medication. Approximately 38% of Americans, or 96 million, on several occasions have waited longer than a week for mental health treatment services. Distance is another barrier in that about 46% of the population, have experienced or knew someone who has had to travel for over one-hour roundtrip to seek treatment (National Council for Behavioral Health, 2018). Comment by Dr. Seymour: I moved this here. These are reasons they don’t have access. They are not reasons that they reject care they have access to. This is good because if you have a long list of reasons why they reject--- there is not a reason to do your study. We already know the answer to your research question if these are reasons they REJECT accessible care.

Although many Americans have tried seeking mental health treatment, in addition to the 29% of the population who want to; however, failed to seek the treatment for either themselves or loved ones due to lack of knowing where to go for the services. Statistics also indicate that 21% of adults in the US have tried to see a professional but were unable to do so because of reasons outside of their control (National Council for Behavioral Health, 2018).

· People who do have Access to Mental Health

Medicaid, Medicare, Obamacare started covering mental health care after the implementation of the Affordable Care Act. The shortage of healthcare professionals means they are not willing to participate in treating insured patients because the payments are too low (Carroll, 2019).

· Populations that Use Mental Health Services.

Goldman et al. (2018) in their research found out that women who had been exposed to sexual abuse and drug abuse formed the high numbers of people who utilize mental health services among the Hispanic and non-white people in the county.

· Populations that Reject Mental Health Services.

Augsberger et al. (2015) in support of this research argued that mental health services had been underutilized by Asian women living in this county, as a result of both cultural needs and mismatch of the services offered in the health facilities in this Southern State.

· Reasons for Use of Mental Health Services

Behavioral health treatment, such as psychotherapy and counseling (Barrett, et al., 2009). Mental and behavioral health inpatient and outpatient treatment services (Cohen, 2002), (Peteet, 2019), and (North Texas Help, 2020). Substance use disorder (commonly known as substance abuse) treatment (HealthCare.gov, 2020), (Wang, & Xie, 2019) and (England et al., 2015).

· Reasons for Rejection of Mental Health Services

According to National Council for Behavioral Health, (2018), 31% of Americans are worried about being judged for seeking mental health services, and 21% of the population, have lied to people about seeking mental health services. The stigma is accurate among young Americans, who of course worried of being judged by others when they confess of seeking mental health services (National Council for Behavioral Health, 2018).

Problem Statement

Economic data from city shares that 68% of Hispanics face economic challenges due to limited level of education that limits them to acquire job opportunities contributing to most of them living in a low average income (Herzog et al., 2016). Statistics show that African and Hispanic-Americans minorities are traditionally known to have poorer access to primary care than the Caucasian-Americans (SAMHSA, 2018). While the pattern changed a little due to the Affordable Care Act (ACA), yet, the disparity is still high. The Hispanics low income level and occupational characteristics are associated to low rates of health insurance cover. According to research by the Texas 2018 Mental Health National Outcome Measures (NOMS): SAMHSA Uniform Reporting System, 21.6% of African Americans in South Texas lack healthcare insurance, while the Hispanic or Latino population’s access stands at 26.3%, the reason is directed to low income levels and (SAMHSA, 2018), (Printz, 2015). Asian-Americans are considered under-represented in key government and representation positions contribution to poor access to healthcare. Only 0.8% of Asian Americans access have healthcare insurance that helps them access medical care services including mental health (SAMHSA, 2018), (Gor et al., 2019). The demographic characteristics of persons served by the State Mental Health Authority indicates as follows:

Source: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Texas-2018.pdf

The importance of addressing this problem is because people’s mental health depends on their use or rejection of mental health treatment. Knowing the positive reasons that people take advantage of services may help bring additional people in need in contact with services. Knowing the barriers may lead to policies or programs that can overcome the barriers. Lack of mental health treatment has dire implications in South Texas include lost productivity, unemployment, job absenteeism, and lack of involvement in the community (Mental Health Workforce in Texas, 2016).This is of particular importance in South Texas because of a lack of sufficient mental health professionals to meet the need. Experts in the region state that insufficient local mental healthcare professionals are contributing factors to the hardships being experienced by the police and medical resources, which puts the public safety at risk. Physicians believe that the number of mental health patients are increasing with time more that the current status and attain the level of national epidemic (Albert, 2019). There is trend that as the number of people in need of mental healthcare services keeps increasing, and a number of people qualified to provide help keeps declining (Scripps Media, 2020).

The study area is South Texas and the target group is the mental health providers. The mental health providers include psychiatrists, psychologists, and therapists. The healthcare providers (study sample) are drawn from 12 clinics and approximately 20 providers are targeted. The sample population involves 20 healthcare providers. The unit of analysis is the full group of 20 health care providers. The results will be reported for the full group and not individuals.

The importance of addressing this problem is because people’s mental health depends on their use or rejection of mental health treatment. Knowing the positive reasons that people take advantage of services may help bring additional people in need in contact with services. Knowing the barriers may lead to policies or programs that can overcome the barriers. Lack of mental health treatment has dire implications in South Texas include lost productivity, unemployment, job absenteeism, and lack of involvement in the community (Mental Health Workforce in Texas, 2016). This is of particular importance in South Texas because of a lack of

Sufficient mental health professionals to meet the need. Experts in the region state that insufficient local mental healthcare professionals are contributing factors to the hardships being experienced by the police and medical resources, which puts the public safety at risk. Research by Mental Health Workforce in Texas, (2016), indicates, according Dr. John Lusins “It’s a crisis. It’s been a crisis coming for a while, and it’s not even hit as hard as it will (page 10-11). Number

Other physicians in the regions asserted that it is part of a national epidemic. There is trend that as the number of people in need of mental healthcare services keeps increasing, and a number of people qualified to provide help keeps declining (Scripps Media, 2020).

Purpose of the Study

The purpose of this qualitative descriptive study is to examine how mental health providers describe the factors influencing individuals' decision to utilize or reject mental health services in South Texas. The mental health providers will be asked for strategies to encourage patients to accept and to not reject treatment at the start of treatment and when continuing treatment. The study will employ a qualitative study that will target mental health providers within Southern Texas and document factors impacting utilization and non-utilization of mental services available in the State.

Research Questions

The following research questions will help to guide this qualitative study:

Given that the patients have access to mental health services for all of the following questions:

· RQ 2: What strategies do mental health providers have to encourage patients to begin using mental health services?

· RQ 3: What strategies do mental health providers have to encourage patients to continue using mental health services?

· RQ4: What do mental health providers identify as reasons patients reject mental health services?

· RQ 5: What strategies do mental health providers have to address when patients reject beginning to use mental health services?

· RQ 6: What strategies do mental health providers have to address patients who reject to continue using mental health services?

The gap in the literature is a need to identify the reasons why people use or reject mental health treatment (Lund, et al. 2018). The gap was used to define the problem statement which it is not known how mental health providers describe the factors influencing individual decisions to utilize or reject mental health services. This study will address the challenges that affect healthcare providers and also parents of the mental health patients by understanding the causes and reasons why the patients reject treatment. The study research questions each then targets uncovering these reasons contributing to the mental health patients use or rejection of treatment. This study will add to the literature which focuses now on stigma and insurance and broaden it to look at the reasons patients who have access to treatment choose to use or reject it. For example, there is research that many people drop out of therapy before they planned to (O’Keeffe, et al., 2019). These people had access but chose to reject therapy. If it is known why patient reject treatment, then it becomes possible to develop policies or plan interventions to decrease the likelihood that they will reject treatment. This research will be a first step towards finding solutions but better defining the problems from the perspectives of the mental health professionals (Klymchuk et al., 2019).

The results will help and be of value to practitioners in determining the necessary strategies to be used to allow more individuals to receive the necessary health care services that they require. The information will be used by healthcare professionals during awareness programs about mental health (England, 2015). The information also is relevant for providers when handling mental health patients and also relatives for home care. In addition, it will help to establish effective methods that will be successful at implementing and sustaining interventions in therapy and for training purposes for providers (England, 2015).

The results may enhance knowledge of the Social Cognitive Theory, by extending it to the context of mental health promotion and prevention. It may help to describe how motivations in health and behaviors are influenced by the interaction of people's beliefs, environment, and behaviors (Morin, 2019). For example, people may be motivated to reject therapy because of their beliefs according to this theory (Peteet, 2019). Or they may be motivated to use therapy because of the best interactive behavior of mental health professionals according to this theory (England, 2015).

Qualitative methodology (Colorafi and Evans, 2016) will be used in this study. Qualitative methodology is the most appropriate methodology that provides rich data and not bound by limitations. Qualitative methods are appropriate because it will help to provide real life evidence from the interview with participants that have experiences giving primary data (Kim et al., 2017). In addition, it is also appropriate because data can be obtained to determine the health seeking behaviors (Kim et al., 2017).

It is appropriate for answering the research questions that ask about the reasons that contribute to mental health patients to accept or reject treatment because it provides primary verbal data that is collected in detail. It is appropriate for addressing the problem statement which notes that there are factors that contribute to mental health patients decision whether to reject or accept treatment because of the effectiveness and flexibility in collecting information from the healthcare providers based on their experience.

The qualitative approach is very effective when a phenomenon that is being queried is properly and effectively defined. It is appropriate for this study because the phenomenon is clearly defined as the factors that mental health professionals identify as reasons people utilize or reject mental health services. The literature has determined the causes of the low utilization of mental health in South Texas to include limitations to accessing health care. It also identified other barriers to specialty mental health care utilization (Augsberger, Yeung, Dougher, &Hahm, 2015). What it has not defined are the reasons people use or reject mental health services.

The design for this piece of research will be a qualitative descriptive study. This qualitative descriptive design is the most appropriate design for the problem statement that is not known how mental health providers describe the factors influencing individual decisions to utilize or reject mental health services in South Texas. This is because the method is appropriate for the research to collect data from the mental health providers in depth.

It is appropriate for the research questions because it gives the participant an opportunity express the points in length by choosing their own words. As a researcher more understanding is achieved through open-ended questions.

The population for this study is all (approximately 100) mental health providers in South Texas. This study sample will include 12 clinics and approximately 20 mental health providers. Mental health providers must have at least two years of experience in the field and have current membership in a mental health association as the main participants in the study. The study population for the research will be psychiatrists, psychologists, and therapists. The association involved has the kind of data in their members making the study relevant. The initial sample generation will involve getting a list of mental health providers from the websites of each of the clinics. The clinics will be asked to cooperate with the study by sending an email with the informed consent form to their staff on behalf of the researcher. Comment by Dr. Seymour: Why do you need these organization? Just go on the websites of the 12 clinics.

Participants will include people who are members of Mental Health Organizations including:

· Mental Health America (MHA)

· National Institute of Mental Health (NIMH)

· National Alliance on Mental Health (NAMI)

· National Institute of Environmental Health Sciences (NIEHS)

These organizations are needed because they will help to advance our understanding of why people use or reject mental health services. They can recommend some of their members who are mental health professionals that can answer some of our research questions. They are also devoted to addressing the needs of individuals living with the illness and promoting overall mental health care. They have vast knowledge in advocating for preventative services, its early discovery, and intervention measures, including plans of action that can help stop its progression.

The data collection instruments will include a researcher-created interview protocol that will be field tested with two people who are mental health professionals the researcher knows; the data will not be included in the results. It will also include a researcher-created focus group protocol that will be evaluated with an expert panel of two mental health professionals.

To collect the data the researcher will invite employees within the researcher’s organization who are willing to participate in the study especially those meeting the criteria and a minimum of 20 participants. Participation is entirely voluntary, and participants can choose to be withdrawn from the study at any time. Once the sample is selected, the researcher will use Zoom video conference calls to conduct the interviews and retrieve the data. Data will be collected with 1-hour interviews. The focus group will include the first six volunteers in a group Zoom meeting to discuss the focus group questions.

The data will be collected using a qualitative approach. One will be semi-structured interview questions that answer the research question, while the second source of data will involve a focus group. Interview questions will be developed by the researcher. They will contain a section dedicated to each of the research questions.

The focus group protocol will include broader questions that can be discussed in a group setting. For example, participants will be asked to compare three methods for improving patient acceptance of mental health that were shared in the individual interviews

In addition, they will be asked questions via Zoom video calls so that the researcher to uncover the phenomena at hand and detect body language, voice changes and intonation.

The type of data collected will be narrative transcripts from Semi-structured interviews. They will be collecting qualitative data that the participants provide with answers when they are asked predetermined questions that are open-ended in nature. Focus group is a research method that collects descriptive narrative data.

Data Collection

The data collection process will be as follows:

· The process will begin by writing a letter to the dean to get permission.

· After the IRB committee gives its approval for the project to begin, participants will be sought. The study sample is set to include mental health providers within Southern Texas.

· Data collection will only start after candidates have acknowledged and DocuSign signed the consent form.

Informed Consent Procedure

· Participants are approached and informed on the details about the research and what is expected of them. The participants are informed on the purpose of the study, risks and benefits of the participation.

· The target group is then given consent forms to fill and DocuSign if they agree to participate.

· The participants are then assured that their confidentiality is protected as stated in the consent form. The data collected are presented in coded numbers to protect the privacy of the participants.

· The researcher will communicate with the sample to schedule interview with all 20, and focus group with a smaller subset of the first 6 to volunteer during the interview scheduling process.

· The research will be conducted systematically in a way that begins with interviewing the service providers. The process will be as follows:

· Interviews will involve 20 respondents from within Texas.

· Focus group with subset of 6.

· Manual coding will be conducted on all collected data.

· Data will be entered into MaxQDA for analysis.

· Peer Debriefer meetings after analysis complete

· Summaries of each participants codes emailed to participants for member checking. (Code, Defintion, Quote for each code)

· Consolidate Data Analysis into Tables

· Write Results

Data Analysis Procedures

Upon completion of the interviews, each one will be transcribed from zoom transcripts and cleanup the audio that has been recorded. Descriptive analysis will then begin based on the results from the interview and focus group sessions. This type of narrative data collection is justified to answer the research questions with thematic analysis. Non-statistical approach is vital in handling non-numerical data and it provides information of the research in depth and detail (Almalki, 2016). Collected data will first be manually coded for inductive codes that emerge from the data. Common codes across participants will be determined as themes (Braun & Clarke, 2006). The coded themes will then be analyzed, and explanations assigned.

The overall aim of the analysis will be to find a certain level of consensus relating to the factors that influence an individual’s use or reject existing mental health services offered throughout the county. During this initial stage, individual interviews will be conducted, recorded, and transcribed verbatim. This will be followed by the researcher repeatedly reading and listening to the content to become intimately familiar with it.

· Data will be collected and analyzed for the study.

· Descriptive statistics will be used to summarize the acquired data.

· Coding will be used to address the questions posed.

· A narrative summary will be developed.

The researcher will use MAXDQA in organizing and visualizing data. According to Braun and Clarke (2006), the following six-step thematic analysis process is effective in identifying the relevant patterns in data.

· Stage 1: Become familiar with the data: the researcher is expected to already be familiar with the contents of the research and have a better understanding of it. This is because the researcher is the individual who will collect the data.

· Stage 2: Generate first codes regarding the significant ideas discovered in the data. Pertinent data relating to each code should be combined together.

· Stage 3: This stage allows the researcher to start the search for themes via analysis and a review of the codes. This stage is also designed to better understand those responses that can be developed into acceptable themes.

· Stage 4: Reviewing and refining the themes and determining if there are any of them that need to be removed, combined, or if they can be broken down into additional themes.

· Stage 5: Define and name the themes after refining them.

· Phase 6: Generate the final report by the researcher.

Once the researcher is familiar with the data by reading through the data and looking for patterns, a detailed description of the phenomenon from the synthesis of the data will be developed.

Ethical Considerations

Before the commencement of the study, the researcher will contact his organization to explain the proposed study. Once the organizational and IRB approvals are given, the organization will provide a list of qualified candidates and an email invitation will be sent to the mental health professionals regarding participation in the study. Participants will be recruited by asking the staff secretaries to forward an email from me to the staff. The email will include an invitation to participate and the informed consent documentation. Participants will contact the researcher through email or phone call to participate. The participants will use DocuSign to sign the informed consent. Zoom or phone interviews will be conducted with the participants.

All collected data will be used purely for research purposes and remain confidential. No names, organization affiliations, or other identifiable data will be utilized and revealed in the study. Respondents can freely withdraw from the study, and they will be continually reminded of this at every state. No personal name or organizational names that may bring conflict of interest in the research will be included. Fake names will be assigned to each participant and will be the only names used throughout the study. The DocuSign informed consent will be saved in a password protected folder on my personal computer and a password protected thumb drive in a locked drawer in my home office.

The research will remain property of the University will all rights reserved. Additionally, only relevant data that covers the specific scope of this study will be collected by the researcher. The researcher will steer clear of any bias, perceived or otherwise, and remain subjective as the data is analyzed so as to further prevent any harm on the part of the participants. Considering the nature of this qualitative research, interactions between the researcher and participants may face ethical challenging in different stages of the research. During the data collection, ethical concerns that might occur among others include anonymity, confidentiality, informed consent, researchers’ potential impact on the participants and vice versa.

References

Armbruster, P., Gerstein, S., & Fallon, T. (1997). Bridging the gap between service need and service utilization: A school-based mental health program. Community Mental Health Journal, 33(3), 199-211. doi:10.1023/A:1025033326743

O'Keeffe, S., Martin, P., Target, M., & Midgley, N. (2019). 'I just stopped going': A mixed methods investigation into types of therapy dropout in adolescents with depression. Frontiers in Psychology, 10, 75. doi:10.3389/fpsyg.2019.00075

Picco, L., Lau, Y. W., Pang, S., Abdin, E., Vaingankar, J. A., Chong, S. A., & Subramaniam, M. (2017). Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: Findings from a cross-sectional survey in Singapore. BMJ Open, 7(8), e018228. doi:10.1136/bmjopen-2017-018228

Schwartz, A. (2017). A report on the demographic changes and changing needs of fort bend county University