Many mental health disorders are often diagnosed in adolescence, suggesting the well-being of adolescent mental health should be a public health priority. The prevalence of adolescent mental health issues has led researchers to investigate treatment utilization and effectiveness. Findings suggest there is a vast underutilization of care for adolescents and an even greater deficit in family involvement in adolescent mental health care. Yet, existing research neither offers a sound understanding of how parents interpret and understand their child's mental health diagnosis, nor how the parent-child relationship and parental involvement in treatment is experienced.

A qualitative approach examined parents' and caregivers' perceptions of their adolescents' mental health disorder and how parents made decisions about their involvement in their adolescent's treatment in a sample of families already engaged with the mental health care system. Semi-structured interviews with 33 predominately low-income African American parents and caregivers who had parented a teenager diagnosed and/or treated for a depressive disorder when the family was the recipient of Medicaid were conducted. The Ecological Risk and Resilience Framework facilitated an understanding of the dynamics shaping parental involvement in adolescent mental health care.

Grounded theory was used to analyze the data. Findings suggest parents' involvement in the diagnosis process may be initiated after a build-up of problematic events, often identified from sources outside the family. Parental responses to the teens' diagnoses included feeling relief but also confusion, while advocating for the needs of their teenager. The parent-child relationship post-diagnosis reflected four actions: parents being protective, showing patience and empathy, increasing communication with their teen, and teaching the teen accountability. Parents reported they had agency in making decisions about the teen's treatment. They wanted active involvement and saw their involvement as having mutual benefits for both themselves and their teen. Three encouraging components enhanced parental involvement: positive mental health care provider and parent interactions, the parents' own mental health and exposure to mental health care, and spirituality. The availability of insurance also positively supported more involvement. Care barriers included family or teen resistance and lack of resources. Race/ethnicity shaped the expectations parents had of the mental health care system but did not shape parental involvement in treatment. Strategies for forging greater parental connections with mental health treatment and the role mental health care professionals play in this partnership are discussed.