Barriers to Access to Care Evaluation Scale - Proxy Report (BACE-PR): evidence of reliability and validity for caregivers reporting on children and adolescents with mental health concerns in Greece

Background To improve access to mental health care for children and adolescents, it is necessary to identify the barriers faced by their caregivers. The aim of this study is to identify these barriers in Greece and to investigate the reliability and validity of the modified version of the Barriers to Access to Care Evaluation scale (BACE) - the BACE Proxy Report (BACE-PR).

A total of 265 caregivers completed the BACE-PR. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate the factor structure of the instrument. Item parameters were assessed via Item Response Theory. Interpretability was assessed by linking summed scores to IRT-based scores.

Caregivers reported care costs as the major barrier to access. Obsessive compulsive symptoms and self-harm were the conditions for which caregivers reported the highest level of barriers. EFA and CFA suggested that a one-factor solution fit the data well (RMSEA = 0.048, CFI = 0.991, TLI = 0.990). Internal consistency was found to be high (ω=0.96). Average z-scores provided five meaningful levels of caregivers’ perceived barriers compared to the national average.

Caregivers face a variety of barriers to access mental health care for their children and this could partly explain the treatment gap in the Greek mental health sector. Our study provides evidence for the reliability and validity of the BACE-PR scale, which can aid to identify caregiver-perceived barriers and to design interventions to improve access to mental health care. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was fully funded by The Stavros Niarchos Foundation through The Child and Adolescent Mental Health Initiative (CAMHI). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted by the Research Ethics Committee of the Democritus University of Thrace [approval number: ∆ΠΘ/ΕΗ∆Ε/42772/307]. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Mailing address: Child Mind Institute. 215 E 50th St, New York, NY 10022, USA Data Availability The dataset statistical codes supporting the conclusions of the current study are openly available in the CAMHI Open Science Framework repository [http://doi.org/10.17605/OSF.IO/CRZ6H]