Parental perceptions of barriers to psychotherapy: a comparison between parents of children with and without reported trauma exposure.

Parental perceptions of barriers to psychotherapy: a comparison between parents of children with and without reported trauma exposure - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Eur J Psychotraumatol . 2026 Jun 2;17(1):2652819. doi: 10.1080/20008066.2026.2652819 Show available content in en fr Parental perceptions of barriers to psychotherapy: a comparison between parents of children with and without reported trauma exposure Johanna Leppin a, CONTACT , Alexander Tewes b , Hanna Christiansen a , Katharina Szota a Author information Article notes Copyright and License information a Marburg University, Department of Clinical Child and Adolescent Psychology, Marburg, Germany b Lüneburg Institute for Training in Child and Adolescent Behavioural Therapy (LAKIJU-VT), Lüneburg Psychiatric Clinic (PKL), Lüneburg, Germany CONTACT Johanna Leppin leppinjo@staff.uni-marburg.de Marburg University, Department of Clinical Child and Adolescent Psychology, Gutenbergstraße 18, Marburg 35032, Germany Roles Johanna Leppin : Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing – original draft, Writing – review & editing Alexander Tewes : Writing – review & editing Hanna Christiansen : Resources, Supervision, Writing – review & editing Katharina Szota : Conceptualization, Project administration, Supervision, Writing – review & editing Received 2025 Nov 24; Accepted 2026 Mar 23; Collection date 2026. © 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. PMC Copyright notice PMCID: PMC13231806  PMID: 42227216 ABSTRACT Background: Mental disorders often emerge in childhood, affecting individual development and family functioning. Parents are often responsible for seeking mental health care for their child and thereby encounter structural, emotional, and knowledge-related barriers. For parents of children exposed to traumatic events, additional challenges may arise. Objective: This study aims to investigate parental perceptions of barriers to psychotherapy for their child and to compare perceptions between parents of children with and without traumatic experiences. Methods: Perceived barriers were measured with a self-developed 10-item scale. Online survey was conducted with N = 271 parents who had at some point been seeking or receiving psychotherapy for their child. Non-parametric Mann–Whitney-U-tests were performed for several group comparisons: search only ( n = 63) vs. treatment ( n = 208); child with ( n = 71) vs. without traumatic experience ( n = 200); trauma- ( n = 54) vs. non-trauma-related reasons for treatment ( n = 154). Results: Parents reported a moderate level of barriers. The highest agreements were found for waiting time and time investment ( Md = 4.00; IQR = 2 .00). Parents of children who had only sought but not received psychotherapy reported greater difficulties in finding adequate treatment ( p < .05, r = −0.18). Both if children had experienced a traumatic event and if the reason for therapy was trauma-related, parents reported a significantly higher degree of time investment ( p < .05, r = −0.16), the concern that their child might be too burdened ( p < .01, r = −0.20) and lack of confidence in professional competence ( p < .01, r = −0.19). Conclusions: Structural barriers were reported as most prominent. Trauma exposure of the child may further increase perceived barriers. These findings highlight the need for parental support and trauma-informed guidance. KEYWORDS: Child and adolescent mental health, parental barriers, treatment access, PTSD, trauma-informed care HIGHLIGHTS Parents encounter multiple barriers when seeking or engaging in psychotherapy for their child, with structural barriers being most prominent. Children’s exposure to traumatic events may further increase the perception of barriers. Trauma-informed training and guidance for parents, improved access to support, improved trauma-focused training for professionals and transparent communication between professionals and parents are needed. 1. Background Mental disorders frequently manifest during childhood and adolescence and potentially become a lifelong burden. Epidemiological studies of German children and youth demonstrated that approximately every fifth child suffers from mental health problems (Kaman et al., 2025 ). A substantial part of children and adolescents in need do not receive adequate treatment (Rodney-Wolf & Schmitz, 2025 ). This gap can partially be explained by barriers experienced during different stages of help-seeking. Help-seeking in the mental health context is defined as ‘an adaptive coping process that is the attempt to obtain external assistance to deal with a mental health concern’ (Rickwood & Thomas, 2012 ). It has been commonly conceptualized as a sequential and multi-faceted process that unfolds over time. The process typically includes three key phases: (1) problem recognition, where individuals acknowledge the presence of a mental health concern; (2) decision to seek help, involving the intention or the attempt to access professional support; and (3) seeking and engaging in mental health care (Goldsmith et al., 1988 ). Barriers and facilitators can emerge at each stage, but the stages of accessing and engaging in care are especially critical for treatment uptake and long-term outcomes. Barriers to accessing care often include emotional factors (e.g. shame, inability to disclose difficulties), a lack of mental health literacy, and structural barriers such as long waiting times (Aguirre Velasco et al., 2020 ; Pfeiffer & In-Albon, 2022 ). In the phase of engaging and sustaining in mental health care, additional barriers like fear of confidentiality breaches, perceived lack of treatment effectiveness, dissatisfaction with the treatment or therapeutic relationship or the time investment of ongoing treatment may arise (de Soet et al., 2024 ; Roberts et al., 2022 ). In the context of child and adolescent mental health care, the help-seeking process is fundamentally shaped by parental involvement (Mackova et al., 2022 ). Parents are usually the primary decision-makers when it comes to seeking mental health care for their children and their involvement is often crucial in motivating the children and adolescents to remain engaged in treatment (Reardon et al., 2017 ). With parents often acting as gatekeepers to mental health care services for their children, they experience barriers first-hand. Prior studies investigating parents’ perception of barriers to mental health care found that parents often reported structural barriers, the perception that treatment did not meet expectations and the belief that their child’s mental health difficulties were insufficient to warrant treatment (Smith et al., 2013 ; Tapp et al., 2018 ). A particular vulnerable subset of children and adolescents are those who have been exposed to traumatic events. According to the DSM-5, an event is classified as traumatic if it involves ‘exposure to actual or threatened death, serious injury, or sexual violence’ (APA, 2018 ). Approximately every second child experiences at least one traumatic event before entering adulthood (McLaughlin et al., 2013 ). About 12% of trauma-exposed children and youth develop post-traumatic stress disorder (PTSD, Visser et al., 2025 ). PTSD is characterized by intrusions, avoidance, negative alterations in cognitions and mood, increased arousal and constraints in everyday life and functional capacity (APA, 2018 ). Guidelines recommend trauma-focused treatment (Rosner et al., 2019 ), with the therapy method with the highest level of evidence for children and adolescents being trauma-focused cognitive behavioural therapy (TF-CBT; Thielemann et al., 2022 ). The repercussions described of childhood trauma frequently extend to the family system in its entirety. Established interaction and support concepts can be destabilized, the distribution of roles within the family can change, and in addition to the burdened child, parents are often also affected by emotional stress and demands when it comes to supporting their child (Russin & Stein, 2022 ). Oftentimes, parents are burdened by (secondary) posttraumatic stress themselves, which can lead to dysfunctional posttraumatic cognitions and behaviours, such as anxiety and avoidance, shame and guilt (Tutus & Goldbeck, 2016 ). Such parental dysfunctional cognitions and behaviours may contribute to the maintenance of the child’s posttraumatic stress (Hiller et al., 2018 ). TF-CBT therefore explicitly stipulates the involvement of a caregiver in the therapy process which improves symptom reduction, family climate, and reduces parental dysfunctional cognitions (Cohen et al., 2009 ; Tutus et al., 2019 ; Yasinski et al., 2016 ). However, this approach is primarily indicated when the parent is a non-offending caregiver. In cases of child maltreatment, parents may be directly involved in their children’s traumatic experiences as perpetrators or contributing figures. Such involvement can fundamentally alter their role in treatment and may limit or modify the appropriateness of caregiver participation in therapy (Brown et al., 2020 ). Despite a high level of suffering among affected children and families, many do not receive adequate trauma-focused treatment (Ganser et al., 2016 ). Barriers that children and adolescents are faced with after trauma exposure include avoidance, fear that the experience will not be taken seriously and increased feelings of shame and guilt (Münzer et al., 2016 ; Truss et al., 2023 ). Parents of children exposed to trauma frequently report insufficient knowledge about adequate treatment, the perception that professionals do not take the child seriously and fears of being burdened by trauma-related stress themselves (Williamson et al., 2019 ). While multiple structural, emotional and knowledge-related barriers to mental health care for children and adolescents, as perceived by the parents, have been identified in previous research (Reardon et al., 2017 ), to our knowledge, no study has directly compared parental perceptions of barriers across different help-seeking stages between parents of children with and without traumatic experiences. Such research is of practical importance, as the development of effective interventions to improve service uptake and retention requires detailed insight into the distinct barriers experienced by different populations. The present study therefore aims to directly compare the perspectives of parents of children and adolescents with and without traumatic experiences regarding the barriers they perceive both when initiating and during treatment of their children. We pose the following exploratory research questions: To what extent do parents who have sought or received psychotherapy for their child perceive access and (hypothetical) treatment barriers? Do perceived barriers differ between parents who have only sought psychotherapy for their child and those whose children have received treatment? Do perceived barriers differ between parents whose children have vs. have not experienced a traumatic event? Do perceived barriers differ between parents of children who have vs. have not entered psychotherapy for trauma-related reasons? 2. Methods 2.1. Participants and procedure The Ethics Committee of the German Psychological Society (DGPs) approved the general implementation of studies via the ‘German Mental Health Barometer’ (application number: 2023-12-22VA). This specific study was conducted in strict accordance with the ethical standards of the DGPs. Informed consent was obtained from all participants. Data for the analyses were collected as part of an online survey on parents’ attitudes towards group-based parent training. Recruitment was conducted through the ‘German Mental Health Barometer’ ( www.deutsches-gesundheitsbarometer.de ) from 2/24/2025 to 3/16/2025. The ‘German Mental Health Barometer’ is a population-based online-panel conducted by the German Center for Mental Health (DZPG, partner site Bochum-Marburg) and Mental Health Research and Treatment Center (FBZ, Ruhr Universität Bochum). The work on the panel is supported by experts by experience. Experts by experience are people who have gained special expertise through their own experiences or the experiences in their close network with mental health crises and issues and their recovery. Adults residing in Germany can register for this online platform and subsequently participate in surveys if they meet the respective inclusion criteria. Participation was compensated with 2 euros. Individuals were eligible to participate if they were of age and had at least one child between 0 and 18 years. For the analysis presented in this study, only data from parents who stated that they had at some point been seeking or engaging in psychotherapy for their child have been considered. The survey only inquired about mental health care in the form of psychotherapy. An a priori power analysis was conducted with g*Power (Faul et al., 2007 ), revealing a necessary total sample size of N = 106 to detect a medium effect ( d = 0.5, Power = 80 %, α = .05) for non-parametric Mann–Whitney-U-tests with two groups. A preregistration took place prior to the examination of the data on the platform AsPredicted ( https://aspredicted.org/wtsc-6pfc.pdf ). 2.2. Measures Standard socio-demographic information of the parent was assessed (age, gender identity, educational background, net income, marital status). Additionally, parents were asked whether they were currently receiving psychotherapy themselves and how many children they have. A series of dichotomous yes/no questions assessed whether parents had ever sought psychotherapy for their child(ren), whether the child(ren) had ever received psychotherapy, and whether they had experienced a traumatic event (e.g. sexual or physical violence, accident). In instances of positive responses to the last item, an additional yes/no question was employed to determine whether the child(ren) had received treatment because of the traumatic experience. Given the absence of a validated and German-language instrument assessing parent-reported barriers to accessing and engaging in psychotherapy for children that was sufficiently concise for use within a larger survey, we developed a new instrument to assess the perception of barriers to psychotherapy. Previous results of empirical investigations of barriers were considered during development (Aguirre Velasco et al., 2020 ; Pfeiffer & In-Albon, 2022 ; Smith et al., 2013 ; Tapp et al., 2018 ; Truss et al., 2023 ; Williamson et al., 2019 ). Items were designed to cover barriers across different stages of the help-seeking process, including accessing care (e.g. ‘extended waiting time’) and engaging in treatment (e.g. ‘limited caregiver-involvement in therapy’). All ten items can be found in Table 2 . The parents were asked to rate the extent to which they would expect to experience or have experienced the occurrence of the presented difficulties while seeking or engaging in psychotherapy for their children on a 5-point Likert scale (1 = does not apply at all , 2 = applies a little , 3 = partly/partly , 4 = tends to apply , 5 = applies completely ). In the main sample, Cronbach’s Alpha of 0.88 provides evidence for good reliability. Equally good to excellent reliability was found for all subsamples, with Cronbach’s Alpha ranging from 0.83 to 0.92. Table 2. Descriptive statistics of the main sample ( N = 271). Barrier M (SD) Md (IQR) Mode Score range Extended waiting time 3.91 (1.28) 4 (2.00) 5 1–5 Long distance to therapy sessions 3.16 (1.41) 3 (2.00) 4 1–5 Not knowing how to find treatment 2.99 (1.45) 3 (2.00) 1 1–5 Time investment 3.55 (1.27) 4 (2.00) 5 1–5 Child is too burdened to talk about problems 3.28 (1.30) 3 (2.00) 4 1–5 Therapy may not help the child 2.85 (1.40) 3 (2.50) 1 1–5 Therapists may not understand the child 2.54 (1.42) 2 (3.00) 1 1–5 Insufficient information about treatment options 3.07 (1.40) 3 (2.00) 4 1–5 Lack of confidence in the competence of professionals 2.56 (1.41) 2 (3.00) 1 1–5 Limited caregiver involvement in therapy 2.58 (1.36) 3 (3.00) 1 1–5 Open in a new tab Notes . Given the non-normal distribution of the ratings, medians and interquartile ranges (IQR) are reported as well as means and standard deviations. 2.3. Sample characteristics A total of 1183 parents between the age of 19 and 78 years participated in the survey. N = 330 met the inclusion criteria for this study. The data of n = 49 participants contained non-valid responses, characterized by strings of numbers or generic filler responses, which led to their exclusion from further analyses. Additionally, n = 10 datasets have been excluded from the dataset due to obvious multiple participation by the same individuals. The main sample thus consists of N = 271 parents. Participants’ age ranged from 20 to 70 years old ( M = 44.51 years, SD = 8.03, Skewness = −0.23, Kurtosis = 3 .09). Regarding gender, 57% of the respondents self-identified as female, 42% as male and 1% as diverse. A total of 29% of the parents were currently undergoing psychotherapy themselves. The number of children ranged from 1 to 6 ( M = 1.96, SD = 0.91). Detailed socio-demographic characteristics can be derived from Table 1 . Table 1. Socio-demographic characteristics of the parents. Socio-demographic variables of the parents Main sample ( N = 271) Age (in years) M (SD) 44.51 (8.03) Range 20–70 Gender identity (in %) Female 57.2 Male 42.1 Diverse 0.7 Education (in %) No school leaving certificate 0.4 Basic secondary education 6.3 Intermediate secondary education 30.6 Specialized A-levels 8.1 A-levels 53.9 Other 0.7 Net income (in %) Income level 1 (<500 to <1500 €) 5.5 Income level 2 (1500 to <2500 €) 13.7 Income level 3 (2500 to <4000 €) 26.9 Income level 4 (4000 to <5500 €) 28.0 Income level 5 (>5500 €) 23.3 No information 2.6 Marital status (in %) Married 68.6 Single 8.1 Single parent 10.7 Partnership 10.3 Other 2.2 Current parental psychotherapy (in %) Yes 28.8 Number of children M (SD) 1.96 (0.91) Range 1–6 Open in a new tab 2.4. Data analysis The statistical analysis was conducted using the RStudio software (R Core Team, 2021 ). Analysis of missing values revealed no missing data in the relevant variables. Inter-item correlations among the ten barrier variables revealed, on average, positive moderate correlations (see Appendix 1). The subgroups resulting from the examination of group differences were examined for differences in socio-demographic variables using Firth’s penalized likelihood regression, indicating no significant between-group differences (see Appendix 2). Shapiro–Wilk tests indicated non-normality for all dependent variables ( p < .01); therefore, non-parametric Mann–Whitney-U-tests were performed. Before conducting those tests, distribution shapes were examined using Kolmogorov–Smirnov tests. For variables with differing distributions, results are interpreted as reflecting distributional differences rather than median differences alone. In case of differences between parents who have only sought help vs. those whose children have engaged in psychotherapy (research question 2), we address potential bias by removing the barriers differentiating the groups. To adjust the p -values for multiple testing, the Bonferroni method will be applied. 3. Results 3.1. Descriptive statistics The descriptive statistics of the main sample indicate an overall moderate to high extent of perceived difficulties (see Table 2 ). Parents showed the strongest agreement on the barriers of extended waiting time and time investment ( Md = 4, IQR = 2 .00). The least agreed upon barriers were doubts about the therapist’s ability to understand the child and lack of confidence in the competence of professionals ( Md = 2, IQR = 3 .00). 3.2. Differences in perceived barriers of the subsample ‘treatment’ and the subsample ‘search only’ Kolmogorov–Smirnov tests indicated that the distribution only differs between groups for the barrier extended waiting time ( p = .049). The results of the Mann–Whitney-U-tests are presented in Table 3 . Table 3. Results of Mann-Whitney- U -tests (treatment vs. search only). Barriers to psychotherapy Subsample treatment ( n = 208) Subsample search only ( n = 63) U Z p adj r Md (IQR) Md (IQR) Extended waiting time 4.00 (2.00) 5.00 (1.00) 5154.0 −2.57 .060 −0.16 Long distance to therapy sessions 3.00 (2.00) 3.00 (3.00) 6163.5 −0.71 1.000 −0.04 Not knowing how to find treatment 3.00 (3.00) 4.00 (2.50) 4976.5 −2.89 .030* −0.18 Time investment 4.00 (3.00) 4.00 (2.00) 5352.0 −2.20 .230 −0.13 Child is too burdened to talk about problems 3.00 (2.00) 3.00 (2.00) 6492.5 −0.11 1.000 −0.01 Therapy may not help the child 3.00 (3.00) 3.00 (2.00) 5828.0 −1.33 1.000 −0.08 Therapists may not understand the child 2.00 (3.00) 3.00 (3.00) 6092.0 −0.84 1.000 −0.05 Insufficient information about treatment options 3.00 (2.00) 4.00 (3.00) 5087.5 −2.69 .060 −0.16 Lack of confidence in competence of professionals 2.00 (3.00) 3.00 (1.00) 6194.0 −0.66 1.000 −0.04 Limited caregiver-involvement in therapy 3.00 (3.00) 3.00 (1.50) 6355.5 −0.36 1.000 −0.02 Open in a new tab Notes . p adj = Bonferroni -adjusted p -value; r = rank-biserial correlation coefficient; * p ≤ .05. The perception of the extent of the occurrence of barriers differed significantly for the barrier of not knowing how to find a suitable treatment ( U = 4976.5, Z = −2.89, p adj < .05). This effect can be interpreted as a small negative effect ( r = −0.18; Cohen, 1988 ). Parents of children who had only been seeking, but never received psychotherapy, reported a higher extent of occurrence of not knowing how to find suitable treatment compared to parents whose children had received psychotherapy. Therefore, this specific barrier was excluded from further analyses. 3.3. Differences in perceived barriers between parents of children with and without traumatic experiences Kolmogorov–Smirnov tests indicated that the distributions differ between the groups for the barriers that a child is too burdened to talk about problems and lack of confidence in the competence of professionals ( p < .01). Results of the Mann–Whitney-U-tests can be derived from Table 4 . Table 4. Results of Mann-Whitney- U -tests (traumatic experience vs. no traumatic experience). Barriers to psychotherapy Subsample traumatic experience ( n = 71) Subsample no traumatic experience ( n = 200) U Z p adj r Md (IQR) Md (IQR) Extended waiting time 4.00 (1.50) 4.00 (2.00) 7048.0 −0.09 1.000 −0.01 Long distance to therapy sessions 3.00 (2.50) 3.00 (2.00) 6569.0 −0.94 1.000 −0.06 Time investment 4.00 (2.00) 4.00 (3.00) 5570.0 −2.70 .045* −0.16 Child is too burdened to talk about problems 4.00 (2.00) 3.00 (2.00) 5204.0 −3.34 .009** −0.20 Therapy may not help the child 3.00 (2.00) 3.00 (3.00) 6098.0 −1.77 .639 −0.11 Therapists may not understand the child 3.00 (3.00) 2.00 (2.00) 5640.5 −2.57 .072 −0.16 Insufficient information about treatment options 4.00 (3.00) 3.00 (2.00) 6033.0 −1.88 .495 −0.11 Lack of confidence in competence of professionals 3.00 (3.50) 2.00 (2.00) 5336.5 −3.11 .009** −0.19 Limited caregiver-involvement in therapy 3.00 (2.50) 2.00 (2.00) 5881.5 −2.15 .243 −0.13 Open in a new tab Notes . p adj = Bonferroni -adjusted p -value; r = rank-biserial correlation coefficient; * p ≤ .05; ** p ≤ .01. Statistically significant group differences were found for the barriers of time investment ( U = 5570.0, Z = −2.70, p adj < .05, r = −0.16), the child being too burdened to talk about its challenges ( U = 5240.0, Z = −3.34, p adj < .01, r = −0.20) and the lack of confidence in the competence of professionals ( U = 5336.5, Z = −3.11, p adj < .01, r = −0.19). All effects can be interpreted as small negative effect sizes ( r ranging from −0.16 to −0.20). Parents of children who were exposed to traumatic events report a significantly higher extent of those barriers compared to parents whose children have never experienced a traumatic event. 3.4. Differences in perceived barriers between parents of children entering psychotherapy for trauma- vs. non-trauma-related reasons Kolmogorov–Smirnov tests indicated that the distributions differ between groups for the barriers that the child is too burdened to talk about problems and doubts about the therapist’s ability to understand the child ( p < .05). Results of the Mann–Whitney-U-tests are presented in Table 5 . Table 5. Results of Mann-Whitney- U -tests (trauma-related vs. non-trauma-related reasons for therapy). Barriers to psychotherapy Subsample trauma-related reasons ( n = 54) Subsample non-trauma-related reasons ( n = 154) U Z p adj r Md (IQR) Md (IQR) Extended waiting time 4.00 (2.00) 4.00 (2.00) 5462.0 −0.77 1.000 −0.05 Long distance to therapy sessions 4.00 (2.00) 3.00 (2.00) 4946.5 −1.77 .639 −0.11 Time investment 4.00 (2.00) 3.00 (2.00) 4454.0 −2.73 .045* −0.17 Child is too burdened to talk about problems 4.00 (2.00) 3.00 (2.00) 3782.5 −4.03 .000*** −0.25 Therapy may not help the child 3.50 (3.00) 3.00 (3.00) 4784.0 −2.09 .297 −0.13 Therapists may not understand the child 3.00 (3.75) 2.00 (2.00) 4541.0 −2.56 .072 −0.16 Insufficient information about treatment options 4.00 (2.00) 3.00 (2.00) 5592.0 −0.52 1.000 −0.03 Lack of confidence in competence of professionals 4.00 (4.00) 2.00 (2.00) 4197.5 −3.22 .009** −0.20 Limited caregiver-involvement in therapy 3.00 (2.75) 2.00 (2.75) 4801.5 −2.05 .315 −0.13 Open in a new tab Notes . p adj = Bonferroni -adjusted p -value; r = rank-biserial correlation coefficient; * p ≤ .05; ** p ≤ .01; *** p ≤ .001 Statistically significant group differences were found for the barriers of time investment ( U = 4454.0, Z = −2.73, p adj < .05), the child being too burdened to talk about problems ( U = 3782.5, Z = −4.03, p adj < .001) and a lack of confidence in the competence of professionals ( U = 4197.5, Z = −3.22, p adj < .01). Effect sizes can be interpreted as small negative effects ( r ranging from −0.17 to −0.25). Parents of children who had trauma-related reasons for treatment reported a higher extent of occurrence of those barriers compared to parents of children whose reasons for psychotherapy uptake were different. 4. Discussion The present study investigated parents’ perceptions of barriers to accessing and engaging in psychotherapy for their children. Overall, parents reported a moderate extent of occurrence for most barriers with medians ranging from 2 to 4 on a 5-point scale. Parents who exclusively sought treatment for their child reported a significantly higher extent of not knowing how to find adequate treatment. Parents of children who experienced a traumatic event and parents of children whose reasons for treatment were trauma-related demonstrated a significantly higher extent of time investment, their perceived child’s burden to talk about its challenges and lack of confidence in the competence of professionals. These findings offer insights into the challenges parents face when seeking psychotherapy for their children, particularly following exposure to trauma. Overall, extended waiting times and time investment were the most reported barriers. This underscores a fundamental challenge within the mental health care system. On average, families in Germany are confronted with a waiting period of six months before receiving psychotherapy for the affected child (Plötner et al., 2022 ), a delay especially problematic given that childhood and adolescence are vulnerable development phases, where timely offered treatment is crucial to prevent chronicity (Colizzi et al., 2020 ). Extended waiting times may hinder access into the care system, whereas the time investment required during therapy may affect continued engagement and adherence. Additionally, the burden resulting from caring for a child with mental illness can lead to long-term adverse health consequences and a reduced quality of life for the parents (Pereira et al., 2024 ). Those consequences for caregivers might intensify as the duration of untreated illness in children prolongs. The findings underscore the need for interventions in different stages of the help-seeking process, as both access pathways must be simplified and families supported in sustaining engagement over the course of treatment. Parents who exclusively sought psychotherapy for their child reported a significantly higher degree of not knowing how to find suitable treatment, reflecting that this access-related barrier could be crucial in preventing families from effectively entering the mental health care system compared to other access-related barriers. This finding aligns with previous research indicating that a lack of information regarding where and how to seek help is among the most commonly reported barriers (Hansen et al., 2021 ; Reardon et al., 2017 ), calling for the need for more parental guidance and improved parental mental health literacy. Apart from parents, teachers and educators frequently are the first to notice children and adolescents struggling, which is why they often play an important role in directing families toward adequate care (Beames et al., 2022 ). However, many of these professionals report limited knowledge of child mental health and trauma in particular, and they feel inadequately prepared to address such issues, which reduces their reliability as sources of guidance (Gunawardena et al., 2024 ). The complexity of access pathways to treatment may further explain the parents’ insecurity. For families already confronted with the difficulties associated with the child's symptoms, the process of scheduling appointments in multiple facilities, such as general practitioners, psychiatrists and psychotherapists, presumably presents a significant challenge. Our findings underline the necessity of interventions that facilitate pathways and provide parents with dependable guidance to ensure more information about and improved access to mental health care. Although such guidance is already available, for example through the Federal Chamber of Psychotherapists in Germany (BtPK, https://www.elternratgeber-psychotherapie.de/ ), it appears to be insufficiently disseminated. Of the main sample, n = 71 (26%) parents reported that their child had experienced a traumatic event. This finding is in contrast to studies using self-report, which have indicated that the prevalence of traumatic events during childhood and adolescence can reach more than 60% (McLaughlin et al., 2013 ). The rate found in this study does, however, align with previous studies examining parents’ report of their children’s trauma exposure (Tingskull et al., 2015 ). It should be noted that the potential underestimation of children’s trauma exposure by parents might also significantly influence the interpretation of group comparisons in this study. If a proportion of children with traumatic experiences have been wrongly categorized as non-exposed due to limited parental awareness, observed between-group differences may be weakened and true differences in perceived barriers could be more pronounced than reflected in the current findings. This highlights the importance of directly questioning the child about traumatic experiences, rather than relying solely on parental reports. Regarding the perceptions of parents of children with trauma exposure, three engagement-related barriers were perceived as significantly more prevalent: The parents’ concern that the child is too burdened to talk about its difficulties, a lack of confidence in the competence of professionals and time investment. While these findings suggest an increased perception of barriers after child trauma exposure, they represent associations rather than causality, and the influence of child trauma exposure on parental perceptions of barriers remains unclear. The barrier ‘the child is too burdened to talk about its challenges’ was not directly measured as trauma-related avoidance, but it may reflect avoidance processes commonly associated with post-traumatic stress reactions. This interpretation is in line with prior studies suggesting that not being able or willing to talk about the trauma is one of the most prominent barriers (Münzer et al., 2016 ; Truss et al., 2023 ). Children and adolescents may not disclose their traumatic experiences due to shame, fear of stigmatization, threats from the perpetrator or not wanting to burden their parents (Münzer et al., 2016 ). In this study, the child’s burden was only reported as perceived by the parent. After learning about their child’s trauma exposure, parents are often preoccupied with their child’s vulnerability and worry about permanent change and damage to the child or family (Williamson et al., 2019 ). They have often been exposed to traumatic experiences themselves and therefore carry posttraumatic stress as well as guilt related to the child’s trauma (Tutus & Goldbeck, 2016 ). Consequently, parents often demonstrate trauma-related negative cognitions and behaviours themselves, thereby encouraging the trauma-related avoidance of their child, which may increase the child’s perceived burden and prevent the processing of the experience (Cobham et al., 2016 ; Williamson et al., 2019 ). This parental demonstration and reinforcement of avoidance might be an additional barrier to trauma therapy, as parents might overestimate their child’s reluctance to discuss its experiences and thus delay treatment. This concern needs to be further addressed by gatekeepers and practitioners, especially given the evidence suggesting that children and adolescents report no or low levels of upset and high acceptability of trauma screenings in mental health care facilities (Skar et al., 2019 ). With regard to the lack of trust in the competence of professionals, it is important to note that trust between parents and therapists is crucial in the treatment of children and adolescents, and caregiver involvement is emphasized in treatment guidelines (Rosner et al., 2019 ). A strong parent–therapist relationship can enhance parenting skills and improve family climate, and it is also associated with improved therapeutic outcomes and better adherence to mental health care (Hawley & Weisz, 2005 ; Marker et al., 2013 ). In TF-CBT, the involvement of caregivers is considered an important mechanism of change, as parents can improve recovery by providing support and modelling adaptive coping strategies (Brown et al., 2020 ). Trauma-focused interventions including caregiver involvement also result in greater symptom reduction compared to control conditions (Szota et al., 2023 ). However, a lack of trust in professionals may prevent parents not only from seeking but also from engaging in mental health care for their child (Taylor, 2023 ). Previous negative experiences with healthcare or social services may contribute to a lack of trust in professionals (Baker-Ericzén et al., 2013 ). Such experiences may be especially common after trauma exposure, with families reporting that their concerns were not taken seriously (Hansen et al., 2021 ). Furthermore, parents may fear judgement by therapists and therefore question their confidentiality, especially when the trauma was experienced within the family (Mason et al., 2020 ). Distrust in professionals might also be reinforced by cultural and systemic factors, such as a lack of cultural competence among professionals or prejudices toward families with low socioeconomic status, which underlines the importance of improved sensitive approaches to trauma treatment (Ennis et al., 2020 ). In addition, therapists often report insufficient training in trauma-focused methods (Szota et al., 2021 ), as well as an inadequate fear of exacerbating their patient’s traumatic stress during therapy (Finch et al., 2020 ). It is possible that parents perceive this insecurity, which may diminish their confidence in the therapist’s competence. Addressing parental distrust thus requires a bidirectional approach: therapists need improved trauma-focused training and parents require accessible, trauma-informed guidance that provides clear information about adequate treatment and addresses their concerns and doubts. The barrier ‘time investment’ might be perceived as more prominent by parents of children with trauma exposure due to the complex display of traumatization: Children often experience a variety of symptoms ranging from anxiety and depression to externalizing behaviour, which can extend the diagnostic phase (Hodges et al., 2013 ). The high level of avoidance from all parties involved might also prolong the process of seeking or taking up mental health care. Moreover, parents frequently report inadequate responses from institutions intensifying the time investment, such as a lack of referrals and delayed initiation of treatment (Hansen et al., 2021 ). As the cross-sectional design does not allow causal conclusions, these findings may also reflect non-trauma-related factors not assessed in this study, such as the child’s overall symptom severity or family characteristics. The three barriers discussed were also significantly higher for parents of children who received treatment due to trauma-related reasons. This suggests that these barriers may be particularly salient for families seeking treatment in the context of trauma. However, as the data does not provide information whether the treatment was trauma-focused, these differences should not be interpreted as reflecting experiences within trauma-focused therapy. 4.1. Limitations Several limitations should be considered when interpreting the findings of this study. First, only parental perceptions of barriers were assessed. Thus, it remains unclear whether their potential unawareness of their child’s trauma exposure might affect their perceptions of barriers. A study addressing this issue is planned, where children and adolescents with traumatic experiences will report on barriers themselves. Second, data were collected via an online survey with financial incentives, which may have influenced response validity despite thorough data inspection. Third, no socio-demographic information about the child, including information on psychological diagnoses, age or gender, has been assessed, which limited the contextualization of parental perceptions of barriers. Furthermore, no detailed information about the traumatic events (such as trauma type, symptom severity, timing and chronicity, as well as whether the event would be classified as a traumatic event by professionals) and the applied treatment were collected, which limited the interpretation of group differences and precluded further analyses, e.g. differences in parental perceptions of barriers depending on different types of trauma. Fourth, we only assessed parental psychotherapy, but no further parental psychological factors, such as parental psychopathology or post-traumatic stress, as well as no parent-related barriers (e.g. fear of stigmatization), although they could potentially influence parents’ perceptions of barriers. Fifth, as the scale assessing the perceptions of barriers was developed for the purpose of this study, its construct validity remains uncertain. Although the barriers reflect different stages of the help-seeking process, we did not formally model stage-specific dimensions, which may have resulted in a loss of information regarding potentially underlying domains. Finally, the cross-sectional design of the study does not allow conclusions about causality, leaving it unclear whether trauma exposure increases perceived barriers or whether higher barriers exacerbate trauma-related distress. 4.2. Practical implications and directions for future research As the perception of structural barriers was most prominent, it is crucial to simplify access pathways and to ensure timely availability of services to limit long-term negative effects on children, parents and families. For several barriers, parents whose children had experienced a traumatic event and/or had received treatment due to trauma reported a statistically significantly higher extent. Although a causal interpretation cannot be applied, the possibility that child trauma exposure may contribute significantly to a higher perception of barriers calls for further research. Parents need low-level information about trauma, trauma therapy and treatment in general, possibly applicable in kindergartens, schools or workplaces. Parent training showed positive outcomes on parental knowledge of trauma and improved ability to support their child and should be further disseminated (Konijn et al., 2020 ). To improve guidance for help-seeking parents and families, professional gatekeepers should be trained in trauma-informed guidance. Such programs have already demonstrated positive outcomes in professional knowledge and confidence in working with traumatized children and should be further disseminated (Anderson et al., 2022 ). Additionally, therapists need to be further taught in trauma-focused methods to enhance their competence, making them more reliable sources of adequate support and, therefore, increasing parental trust in the competence of professionals. Projects like the BESTFORCAN project aimed to disseminate trauma-focused therapy in Germany and to offer supervision and training to therapists (Rosner et al., 2020 ). Transparent communication between therapists and parents should be a ground principle to strengthen parent-therapist collaboration and, therefore, improve trust and therapy adherence. Future research could focus on longitudinal designs to clarify causal relationships between trauma exposure, perceived barriers and mental health care engagement. Methodologically, the validation of the instrument developed to assess perceived barriers should be further investigated. Future research could expand the instrument and examine potential underlying dimensions of the scale, such as differences between ‘search barriers’ and ‘uptake barriers’ or between structural, emotional, and knowledge-related barriers, using factor analytic approaches. Furthermore, future analyses could investigate the influence of trauma type and children’s socio-demographic characteristics on parental perceptions of barriers. A comparison of parental and child perceptions of barriers could give more insight into the challenges faced by different family members. To emphasize the importance of facilitators and resilience factors in the help-seeking process, future research should expand beyond an exclusive focus on barriers and also examine these positive influences, enabling a more precise assessment of their relative importance. 5. Conclusion Parents are often responsible for initiating mental health care services for their child and for supporting adherent and successful treatment. While doing so, they perceive multiple barriers, with structural challenges being perceived as particularly challenging. Trauma exposure of the child may further amplify perceived barriers, especially regarding the child being too burdened, according to the parents, to disclose difficulties, and parental doubts about professional competence. These findings highlight the need for more support and trauma-informed guidance for parents. Reducing waiting times and other structural barriers, strengthening multi-professional collaboration, enhancing trauma-focused training and promoting transparent communication between parents and therapists are important strategies to improve mental health care uptake and adherence. Addressing both structural and trauma-related barriers is crucial to ensure that affected children and families can access timely and adequate mental health care to prevent long-term adverse effects. Declaration of generative artificial intelligence (AI) and AI-assisted technologies in the writing process The authors declare that during the preparation of this work, the AI-assisted tool ‘DeepL Write’ (free version) was used to improve grammar, vocabulary and readability. After the usage of this tool, the content of this work was critically revised and edited by the authors. Acknowledgements This study has been endorsed by the German Center for Mental Health (DZPG). We thank the local management board members of the DZPG partner site Bochum-Marburg: Prof. Dr. Silvia Schneider, Prof. Dr. Jürgen Margraf, and Prof. Dr. Robert Kumsta. And we thank the team of the German Mental Health Barometer: Prof. Dr. Jürgen Margraf, Prof. Dr. Julia Brailovskaia, and Dr. Lena-Marie Precht. The Ethics Committee of the German Psychological Society (DGPs) approved the general implementation of studies via the ‘German Mental Health Barometer’ (application number: 2023-12-22VA). The study was conducted in strict accordance with the ethical standards of The German Psychological Society (DGPs). Informed consent was obtained from all participants prior to participation. JL designed the questionnaire used in this study, analyzed the data and drafted the manuscript with the support of KS. KS, AT and HC commented on the initial draft and critically revised it. All authors have read and approved the final version of the manuscript. Appendix. Appendix 1 Spearman rank correlation matrix The Spearman rank correlations (Spearman’s ρ) of the ten barriers are presented in a correlation heat map (see Figure A1). Figure A1. Open in a new tab Correlation heat map of perceived barriers. Notes. Spearman rank correlations (Spearman’s ρ ). All correlations are statistically significant ( p < .05). Appendix 2 Firth’s penalized logistic regressions The Firth’s penalized logistic regressions to test for statistically significant differences in relevant socio-demographic variables between the subgroups are presented in Tables A1 to A3. Table A1. Results of Firth’s penalized logistic regression (dependent variable: treatment vs. search only). Predictors (socio-demographic data of the parent) Estimate SE p adj OR Lower 95% CI Upper 95% CI Gender identity (reference category: male) FEMALE −0.37 0.31 1.000 0.69 0.37 1.27 diverse −0.16 1.74 1.000 0.85 0.03 25.71 Age 0.01 0.02 1.000 1.01 0.97 1.05 Level of education (reference level: no school leaving certificate) Basic secondary education 3.39 2.27 1.000 29.57 0.35 2527.59 Intermediate secondary education 4.36 2.24 1.000 77.98 0.97 6275.45 Specialized A-levels 3.88 2.27 1.000 48.44 0.56 4179.95 A-levels 3.71 2.22 1.000 40.84 0.53 3153.02 Other 5.14 2.77 1.000 169.96 0.74 39106.99 Net income (reference level: income level <500 to <1500 €) Income level 2 (1500 to <2500 €) 1.82 0.78 .523 6.19 1.34 28.66 Income level 3 (2500 to <4000 €) 1.11 0.66 1.000 3.05 0.84 11.03 Income level 4 (4000 to <5500 €) 0.60 0.67 1.000 1.82 0.49 6.79 Income level 5 (≥ 5500 €) 0.52 0.70 1.000 1.68 0.43 6.59 No information 2.45 1.56 1.000 11.58 0.54 248.00 Parental mental health care (reference category: yes) No −0.58 0.35 1.000 0.56 0.28 1.12 Marital status (reference category: married) Single 0.91 0.71 1.000 2.49 0.61 10.10 Single parent −0.60 0.48 1.000 0.55 0.21 1.41 Partnership −0.14 0.48 1.000 0.87 0.34 2.24 Other 1.04 1.49 1.000 2.83 0.15 52.53 Number of children (reference category: 1) 2 −0.09 0.34 1.000 0.91 0.47 1.77 3 0.13 0.46 1.000 1.14 0.47 2.81 4 2.35 1.33 0.594 10.51 0.77 143.17 5 0.47 1.73 1.000 1.60 0.05 47.20 6 1.15 1.59 1.000 3.14 0.14 70.52 Open in a new tab Notes . Large CIs reflect sparse data in some categories, where no or few events occurred, leading to high uncertainty in the estimates. Table A2. Results of Firth’s penalized logistic regression (dependent variable: traumatic experience vs. no traumatic experience). Predictors (socio-demographic data of the parent) Estimate SE p adj OR Lower 95% CI Upper 95% CI Gender identity (reference category: male) Female 0.24 0.31 1.000 1.27 0.69 2.32 Diverse −3.41 1.83 .918 0.03 0.00 1.19 Age 0.02 0.02 1.000 1.02 0.98 1.06 Level of education (reference level: no school leaving certificate) Basic secondary education 0.55 1.91 1.000 1.74 0.04 73.81 Intermediate secondary education 1.90 1.86 1.000 6.70 0.18 255.97 Specialized A-levels 1.91 1.94 1.000 6.77 0.15 301.33 A-levels 1.38 1.85 1.000 3.96 0.10 149.95 other 1.50 2.50 1.000 4.49 0.03 599.76 Net income (reference level: income level <500 to <1500 €) Income level 2 (1500 to <2500 €) −0.92 0.98 1.000 0.40 0.06 2.73 Income level 3 (2500 to <4000 €) −1.92 0.89 0.375 0.15 0.03 0.84 Income level 4 (4000 to <5500 €) −1.12 0.93 1.000 0.32 0.05 2.01 Income level 5( ≥ 5500 €) −1.49 0.93 1.000 0.23 0.04 1.41 No information −1.48 1.24 1.000 0.23 0.02 2.61 Parental mental health care (reference category: yes) No 0.93 0.32 .113 2.53 1.34 4.76 Marital status (reference category: married) Single −0.44 0.56 1.000 0.64 0.22 1.92 Single parent −0.74 0.50 1.000 0.48 0.18 1.26 Partnership 0.41 0.56 1.000 1.50 0.50 4.51 Other −0.74 0.94 1.000 0.48 0.08 3.03 Number of children (reference category: 1) 2 −0.12 0.35 1.000 0.89 0.44 1.78 3 −0.80 0.45 1.000 0.45 0.18 1.09 4 −0.59 0.68 1.000 0.56 0.15 2.09 5 −1.32 1.72 1.000 0.27 0.01 7.85 6 −0.71 1.25 1.000 0.49 0.04 5.72 Open in a new tab Notes . Large CIs reflect sparse data in some categories, where no or few events occurred, leading to high uncertainty in the estimates. Table A3. Results of Firth’s penalized logistic regression (dependent variable: trauma-related vs. non-trauma-related reasons for mental health care). Predictors (socio-demographic data of the parent) Estimate SE p adj OR Lower 95% CI Upper 95% CI Gender identity (reference category: male) Female 0.16 0.37 1.000 1.18 0.57 2.43 Diverse −3.05 1.90 1.000 0.05 0.00 1.97 Age 0.03 0.02 1.000 1.04 0.99 1.08 Level of education (reference level: no school leaving certificate) Basic secondary education 0.48 2.00 1.000 1.62 0.03 82.06 Intermediate secondary education 2.63 1.94 1.000 13.87 0.31 621.24 Specialized A-levels 2.91 2.03 1.000 18.30 0.34 973.50 A-levels 2.56 1.94 1.000 12.97 0.29 580.97 other 2.78 2.60 1.000 16.09 0.10 2630.11 Net income (reference level: income level <500 to <1500 €) Income level 2 (1500 to < 2500 €) 0.11 1.13 1.000 1.12 0.12 10.23 Income level 3 (2500 to <4000 €) −1.70 1.00 1.000 0.18 0.03 1.30 Income level 4 (4000 to <5500 €) −0.84 1.08 1.000 0.43 0.05 3.57 Income level 5 ( ≥ 5500 €) −1.47 1.08 1.000 0.23 0.03 1.92 No information −0.01 1.67 1.000 0.99 0.04 25.96 Parental mental health care (reference category: yes) No 0.67 0.37 1.000 1.96 0.95 4.04 Marital status (reference category: married) Single −0.27 0.62 1.000 0.77 0.23 2.59 Single parent −1.02 0.63 1.000 0.36 0.11 1.24 Partnership 0.38 0.65 1.000 1.46 0.41 5.15 Other −0.32 1.09 1.000 0.73 0.09 6.20 Number of children (reference category: 1) 2 −0.18 0.43 1.000 0.84 0.36 1.93 3 −1.06 0.53 1.000 0.35 0.12 0.98 4 −0.61 0.72 1.000 0.54 0.13 2.23 5 −1.23 1.75 1.000 0.29 0.01 9.07 6 1.88 1.71 1.000 6.55 0.23 186.33 Open in a new tab Notes . Large CIs reflect sparse data in some categories, where no or few events occurred, leading to high uncertainty in the estimates. Funding Statement The Digital Panel is funded by the Federal Ministry of Education and Research (BMBF), the Ruhr-Universität Bochum (RUB), and the FBZ within the DZPG. The Digital Panel is funded by the Federal Ministry of Education and Research (BMBF), the Ruhr-Universität Bochum (RUB), and the FBZ within the DZPG. Open Access funding was provided by the Open Access Publishing Fund of Marburg University. Disclosure statement No potential conflict of interest was reported by the author(s). Data availability statement All data and materials used in this study are accessible via the Open Science Framework (DOI: . Open scholarship This article has earned the Center for Open Science badges for Open Data, Open Materials and Preregistered. The data and materials are openly accessible at DOI: 10.17605/OSF.IO/Z4X2V , DOI: 10.17605/OSF.IO/Z4X2V and https://aspredicted.org/wtsc-6pfc.pdf . References Aguirre Velasco, A., Cruz, I. S. S., Billings, J., Jimenez, M., & Rowe, S. (2020). What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry , 20(1), 1–22. 10.1186/s12888-020-02659-0 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Anderson, K. M., Haynes, J. D., Ilesanmi, I., & Conner, N. E. (2022). Teacher professional development on trauma-informed care: Tapping into students’ inner emotional worlds. Journal of Education for Students Placed at Risk (JESPAR) , 27(1), 59–79. 10.1080/10824669.2021.1977132 [ DOI ] [ Google Scholar ] APA . (2018). Diagnostisches und Statistisches Manual Psychischer Störungen DSM-5. Deutsche Ausgabe (P. Falkai & H.-U. Wittchen, Hrsg.; 2. Aufl.) . Hogrefe. [ Google Scholar ] Baker-Ericzén, M. J., Jenkins, M. M., & Haine-Schlagel, R. (2013). Therapist, parent, and youth perspectives of treatment barriers to family-focused community outpatient mental health services. Journal of Child and Family Studies , 22(6), 854–868. 10.1007/s10826-012-9644-7 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Beames, J. R., Johnston, L., O’Dea, B., Torok, M., Boydell, K., Christensen, H., & Werner-Seidler, A. (2022). Addressing the mental health of school students: Perspectives of secondary school teachers and counselors. International Journal of School & Educational Psychology , 10(1), 128–143. 10.1080/21683603.2020.1838367 [ DOI ] [ Google Scholar ] Brown, E. J., Cohen, J. A., & Mannarino, A. P. (2020). Trauma-focused cognitive-behavioral therapy: The role of caregivers. Journal of Affective Disorders , 277, 39–45. 10.1016/j.jad.2020.07.123 [ DOI ] [ PubMed ] [ Google Scholar ] Cobham, V. E., McDermott, B., Haslam, D., & Sanders, M. R. (2016). The role of parents, parenting and the family environment in children’s post-disaster mental health. Current Psychiatry Reports , 18(6), 1–9. 10.1007/s11920-016-0691-4 [ DOI ] [ PubMed ] [ Google Scholar ] Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2. Aufl.) . Routledge. 10.4324/9780203771587 [ DOI ] [ Google Scholar ] Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2009). Traumafokussierte kognitive Verhaltenstherapie bei Kindern und Jugendlichen . Springer. https://link-springer-com.ezproxy.ub.uni-marburg.de/book/9783540885702 . Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: Is it time for a multidisciplinary and trans-diagnostic model for care? International Journal of Mental Health Systems , 14(1), 1–14. 10.1186/s13033-020-00356-9 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] de Soet, R., Vermeiren, R. R. J. M., Bansema, C. H., van Ewijk, H., Nijland, L., & Nooteboom, L. A. (2024). Drop-out and ineffective treatment in youth with severe and enduring mental health problems: A systematic review. European Child & Adolescent Psychiatry , 33(10), 3305–3319. 10.1007/s00787-023-02182-z [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Ennis, N., Shorer, S., Shoval-Zuckerman, Y., Freedman, S., Monson, C. M., & Dekel, R. (2020). Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma-focused cognitive behavioral therapies. Journal of Clinical Psychology , 76(4), 587–611. 10.1002/jclp.22909 [ DOI ] [ PubMed ] [ Google Scholar ] Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods , 39, 175–191. 10.3758/BF03193146 [ DOI ] [ PubMed ] [ Google Scholar ] Finch, J., Ford, C., Grainger, L., & Meiser-Stedman, R. (2020). A systematic review of the clinician related barriers and facilitators to the use of evidence-informed interventions for post-traumatic stress. Journal of Affective Disorders , 263, 175–186. 10.1016/j.jad.2019.11.143 [ DOI ] [ PubMed ] [ Google Scholar ] Ganser, H. G., Münzer, A., Plener, P. L., Witt, A., & Goldbeck, L. (2016). Kinder und Jugendliche mit Misshandlungserfahrungen: Bekommen sie die Versorgung, die sie brauchen? Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz , 59(6), 803–810. 10.1007/s00103-016-2351-6 [ DOI ] [ PubMed ] [ Google Scholar ] Goldsmith, H., Jackson, D., & Hough, R. (1988). Process model of seeking mental health services: Proposed framework for organizing the research literature on help-seeking. In Goldsmith H., Lin E., Bell R., & Jackson D. (Eds.), Needs assessment: Its future (DHHS publication no. ADM 88-1550 (pp. 49–64). U.S. Government Printing Office. [ Google Scholar ] Gunawardena, H., Leontini, R., Nair, S., Cross, S., & Hickie, I. (2024). Teachers as first responders: Classroom experiences and mental health training needs of Australian schoolteachers. BMC Public Health , 24(1), 1–13. 10.1186/s12889-023-17599-z [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Hansen, A. S., Telléus, G. K., Mohr-Jensen, C., & Lauritsen, M. B. (2021). Parent-perceived barriers to accessing services for their child’s mental health problems. Child and Adolescent Psychiatry and Mental Health , 15(1), 1–11. 10.1186/s13034-021-00357-7 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Hawley, K. M., & Weisz, J. R. (2005). Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction, and treatment outcome. Journal of Clinical Child & Adolescent Psychology , 34(1), 117–128. 10.1207/s15374424jccp3401_11 [ DOI ] [ PubMed ] [ Google Scholar ] Hiller, R. M., Meiser-Stedman, R., Lobo, S., Creswell, C., Fearon, P., Ehlers, A., Murray, L., & Halligan, S. L. (2018). A longitudinal investigation of the role of parental responses in predicting children’s post-traumatic distress. Journal of Child Psychology and Psychiatry , 59(7), 781–789. 10.1111/jcpp.12846 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Hodges, M., Godbout, N., Briere, J., Lanktree, C., Gilbert, A., & Kletzka, N. T. (2013). Cumulative trauma and symptom complexity in children: A path analysis. Child Abuse & Neglect , 37(11), 891–898. 10.1016/j.chiabu.2013.04.001 [ DOI ] [ PubMed ] [ Google Scholar ] Kaman, A., Devine, J., Erhart, M., Napp, A.-K., Reiss, F., Moeller, S., Zoellner, F., Behn, S., & Ravens-Sieberer, U. (2025). Youth mental health in times of global crises: Evidence from the German longitudinal COVID-19 and psychological health study. Journal of Adolescent Health , 77(6), 1050–1057. 10.1016/j.jadohealth.2025.05.010 [ DOI ] [ PubMed ] [ Google Scholar ] Konijn, C., Colonnesi, C., Kroneman, L., Liefferink, N., Lindauer, R. J. L., & Stams, G.-J. J. M. (2020). ‘Caring for children who have experienced trauma’ – An evaluation of a training for foster parents. European Journal of Psychotraumatology , 11(1), 1756563. 10.1080/20008198.2020.1756563 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Mackova, J., Veselska, Z. D., Geckova, A. M., Jansen, D. E. M. C., van Dijk, J. P., & Reijneveld, S. A. (2022). The role of parents in the care for adolescents suffering from emotional and behavioral problems. Frontiers in Psychology , 13, 1049247. 10.3389/fpsyg.2022.1049247 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Marker, C. D., Comer, J. S., Abramova, V., & Kendall, P. C. (2013). The reciprocal relationship between alliance and symptom improvement across the treatment of childhood anxiety. Journal of Clinical Child & Adolescent Psychology , 42(1), 22–33. 10.1080/15374416.2012.723261 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Mason, C., Taggart, D., & Broadhurst, K. (2020). Parental non-engagement within child protection services – How can understandings of complex trauma and epistemic trust help? Societies , 10(4), 93. 10.3390/soc10040093 [ DOI ] [ Google Scholar ] McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry , 52(8), 815–830. 10.1016/j.jaac.2013.05.011 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Münzer, A., Fegert, J. M., Ganser, H. G., Loos, S., Witt, A., & Goldbeck, L. (2016). Please tell! Barriers to disclosing sexual victimization and subsequent social support perceived by children and adolescents. Journal of Interpersonal Violence , 31(2), 355–377. 10.1177/0886260514555371 [ DOI ] [ PubMed ] [ Google Scholar ] Pereira, T. L.-B., Wichaikhum, O.-A., Nantsupawat, A., Rajendrana, P., Baladram, S., & Shorey, S. (2024). Recognising the parental caregiver burden of children with mental disorders: A systematic mixed-studies review. International Journal of Mental Health Nursing , 33(6), 1941–1961. 10.1111/inm.13417 [ DOI ] [ PubMed ] [ Google Scholar ] Pfeiffer, S., & In-Albon, T. (2022). Barriers to seeking psychotherapy for mental health problems in adolescents: A mixed method study. Journal of Child and Family Studies , 31(9), 2571–2581. 10.1007/s10826-022-02364-4 [ DOI ] [ Google Scholar ] Plötner, M., Moldt, K., In-Albon, T., & Schmitz, J. (2022). Einfluss der COVID-19-pandemie auf die ambulante psychotherapeutische Versorgung von Kindern und Jugendlichen. Die Psychotherapie , 67(6), 469–477. 10.1007/s00278-022-00604-y [ DOI ] [ Google Scholar ] R Core Team . (2021). R : A language and environment for statistical computing [Software]. https://www.R-project.org/ . Reardon, T., Harvey, K., Baranowska, M., O’Brien, D., Smith, L., & Creswell, C. (2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child & Adolescent Psychiatry , 26(6), 623–647. 10.1007/s00787-016-0930-6 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Rickwood, D., & Thomas, K. (2012). Conceptual measurement framework for help-seeking for mental health problems. Psychology Research and Behavior Management , 5, 173–183. 10.2147/PRBM.S38707 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Roberts, M., Jones, J., Garcia, L., & Techau, A. (2022). Adolescents’ perceptions of barriers and facilitators to engaging in mental health treatment: A qualitative meta-synthesis. Journal of Child and Adolescent Psychiatric Nursing , 35(2), 113–125. 10.1111/jcap.12354 [ DOI ] [ PubMed ] [ Google Scholar ] Rodney-Wolf, K., & Schmitz, J. (2025). Scoping review: Outpatient psychotherapeutic care for children and adolescents in Germany – Status quo and challenges in assessment. Frontiers in Public Health , 13, 1480630. 10.3389/fpubh.2025.1480630 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Rosner, R., Barke, A., Albrecht, B., Christiansen, H., Ebert, D. D., Lechner-Meichsner, F., Muche, R., Zarski, A.-C., & Steil, R. (2020). BEST FOR CAN – Bringing empirically supported treatments to children and adolescents after child abuse and neglect: Study protocol. European Journal of Psychotraumatology , 11(1), 1837531. 10.1080/20008198.2020.1837531 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Rosner, R., Gutermann, J., Landolt, M. A., Plener, P., & Steil, R. (2019). Behandlung der PTBS bei Kindern und Jugendlichen. In Schäfer I., Gast U., Hofmann A., Knaevelsrud C., Lampe A., Liebermann P., Lotzin A., Maercker A., Rosner R., & Wöller W. (Eds.), S3-Leitlinie posttraumatische belastungsstörung (pp. 59–82). Springer. 10.1007/978-3-662-59783-5_3 [ DOI ] [ Google Scholar ] Russin, S. E., & Stein, C. H. (2022). The aftermath of trauma and abuse and the impact on family: A narrative literature review. Trauma, Violence, & Abuse , 23(4), 1288–1301. 10.1177/1524838021995990 [ DOI ] [ PubMed ] [ Google Scholar ] Skar, A.-M. S., Ormhaug, S. M., & Jensen, T. K. (2019). Reported levels of upset in youth after routine trauma screening at mental health clinics. JAMA Network Open , 2(5), e194003. 10.1001/jamanetworkopen.2019.4003 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Smith, T., Linnemeyer, R., Scalise, D., & Hamilton, J. (2013). Barriers to outpatient mental health treatment for children and adolescents: Parental perspectives. Journal of Family Psychotherapy , 24(2), 73–92. 10.1080/08975353.2013.792203 [ DOI ] [ Google Scholar ] Szota, K., Schulte, K. L., & Christiansen, H. (2021). Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen. Kindheit und Entwicklung. https://econtent.hogrefe.com/doi/10.10260942-5403/a000347 . Szota, K., Schulte, K. L., & Christiansen, H. (2023). Interventions involving caregivers for children and adolescents following traumatic events: A systematic review and meta-analysis. Clinical Child and Family Psychology Review , 26(1), 17–32. 10.1007/s10567-022-00415-2 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Tapp, B., Gandy, M., Fogliati, V. J., Karin, E., Fogliati, R. J., Newall, C., Mclellan, L., Titov, N., & Dear, B. F. (2018). Psychological distress, help-seeking, and perceived barriers to psychological treatment among Australian parents. Australian Journal of Psychology , 70(2), 113–121. 10.1111/ajpy.12170 [ DOI ] [ Google Scholar ] Taylor, H. (2023). “The parallel dialogue”: Parental experience of their role in the relationship with their child’s counsellor/psychotherapist. Counselling and Psychotherapy Research , 23(4), 1040–1051. 10.1002/capr.12625 [ DOI ] [ Google Scholar ] Thielemann, J. F. B., Kasparik, B., König, J., Unterhitzenberger, J., & Rosner, R. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child Abuse & Neglect , 134, 105899. 10.1016/j.chiabu.2022.105899 [ DOI ] [ PubMed ] [ Google Scholar ] Tingskull, S., Svedin, C. G., Agnafors, S., Sydsjö, G., deKeyser, L., & Nilsson, D. (2015). Parent and child agreement on experience of potential traumatic events. Child Abuse Review , 24(3), 170–181. 10.1002/car.2287 [ DOI ] [ Google Scholar ] Truss, K., Liao Siling, J., Phillips, L., Eastwood, O., & Bendall, S. (2023). Barriers to young people seeking help for trauma: A qualitative analysis of internet forums. Psychological Trauma: Theory, Research, Practice and Policy , 15(Suppl. 1), S163–S171. 10.1037/tra0001344 [ DOI ] [ PubMed ] [ Google Scholar ] Tutus, D., & Goldbeck, L. (2016). Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD. European Child & Adolescent Psychiatry , 25(9), 997–1005. 10.1007/s00787-016-0821-x [ DOI ] [ PubMed ] [ Google Scholar ] Tutus, D., Goldbeck, L., Pfeiffer, E., Sachser, C., & Plener, P. L. (2019). Parental dysfunctional posttraumatic cognitions in trauma-focused cognitive behavioral therapy for children and adolescents. Psychological Trauma: Theory, Research, Practice, and Policy , 11(7), 722–731. 10.1037/tra0000419 [ DOI ] [ PubMed ] [ Google Scholar ] Visser, I., van der Mheen, M., Dorsman, H., Knipschild, R., Staaks, J., Hein, I., van Dongen, N., Staal, W., Assink, M., & Lindauer, R. J. L. (2025). Post-traumatic stress disorder rates in trauma-exposed children and adolescents: Updated three-level meta-analysis. British Journal of Psychiatry , 13, 1–9. 10.1192/bjp.2025.30 [ DOI ] [ PubMed ] [ Google Scholar ] Williamson, V., Creswell, C., Butler, I., Christie, H., & Halligan, S. L. (2019). Parental experiences of supporting children with clinically significant post-traumatic distress: A qualitative study of families accessing psychological services. Journal of Child & Adolescent Trauma , 12(1), 61–72. 10.1007/s40653-017-0158-8 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Yasinski, C., Hayes, A. M., Ready, C. B., Cummings, J. A., Berman, I. S., McCauley, T., Webb, C., & Deblinger, E. (2016). In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT). Journal of Consulting and Clinical Psychology , 84(12), 1066–1077. 10.1037/ccp0000147 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Citations Data Availability Statement All data and materials used in this study are accessible via the Open Science Framework (DOI: . Articles from European Journal of Psychotraumatology are provided here courtesy of Taylor & Francis ACTIONS View on publisher site PDF (820.4 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

Related documents

• Parental perceptions of barriers to psychotherapy: a comparison between parents of children with and without reported trauma exposure.#255608
• Investigating the Effect of Evidence-based Treatment for Post-traumatic Stress Disorder Among Youth#871276
• Adolescent Perspectives on Parental Consent Requirements for Depression Treatment: A Mixed-Methods Investigation#680156
• The Psychological, Emotional, and Relational Impact of Non-Suicidal Self-Injury on Parents: A Meta-Analysis Protocol#258720
• The VIA Family 2.0 - a Family Based Intervention for Families with Parental Mental Illness#802879