MAPC conducted a total of six focus groups, two with youth and four with parents. Additionally, four key informant interviews were conducted. There were 37 total participants from the focus groups and key informant interviews. There was a clinician on-site for all focus groups—in-person and online.

Detailed focus group information is as follows: 

• 18 people participated across the four parent focus groups  
  • One in-person focus group was conducted in March 2020
  • Three Zoom focus groups were conducted between June and August 2020 
• 14 youth participated across the two youth focus groups  
  • One in-person focus group was conducted in February 2020
  • One Zoom focus group was conducted in July 2020  
• Five key informants participated across four key informant interviews
  

Post Focus Group Survey:

GHD and MAPC recognized the topic of discussion could provide challenges for open and candid discussion among parents and youth. A post focus group survey was developed to provide an opportunity for parents and youth to share any thoughts they might not have had the opportunity to share, or did not feel comfortable sharing, during the focus group. MAPC also used the post focus group survey to gather demographic information such as age of youth, timing of their last mental health interaction, the length of the waiting time before receiving requested services, type of insurance coverage, and reasons for seeking service. Post focus group surveys were voluntary. See appendix for post focus group survey.  

Transcriptions: 

Focus groups were recorded and transcribed for qualitative analysis.  

Key Informant Interviews: 

Initially, MAPC elected to speak with both youth and parents of youth in order to evaluate and understand the landscape of access to youth mental health services in the North Shore. After holding multiple discussions with this target audience, one of the predominant themes that emerged was how youth received and perceived mental health treatment in schools, which suggested that schools are a major access point for youth mental health services. MAPC recognized that by only speaking to parents and youth, data collected around schools would be one-sided. As a result, MAPC expanded the scope to also include school officials: school resource officers, school therapists, and adjustment counselors. This expanded scope allowed for a more comprehensive understanding of the school’s role in youth mental health access. 

Post focus group

Following each focus group, MAPC staff reconvened to share initial thoughts and reactions to the focus group. Initial impressions related to barriers and facilitators were documented on a Post Focus Group document. Through this process, key themes started to emerge and became the basis for code book development that was used for analysis.

Code Book Development

Following completion of all focus groups, MAPC staff reviewed the Post Focus Group document. MAPC staff developed key themes based on the document and created a skeleton code book for qualitative analysis.

Analysis and coding

Two MAPC staff used the skeleton code book to independently perform qualitative analysis on one focus group transcription. MAPC used a qualitative software, Dedoose, for analysis. Each MAPC staff coded the first half of one focus group transcription with a goal to assess the initial codes drafted in the skeleton code book, identify potential new codes, and identify the potential need to remove initial codes. After this process, the two MAPC staff reconvened to compare similarities and differences among the analysis. Final edits produced a second iteration of the code book, which was used for the remaining qualitative analysis.

After conducting two in-person focus groups, the COVID-19 pandemic began and MAPC was no longer able to continue with in-person focus groups. After considering various alternatives, MAPC decided to proceed with virtual focus groups via Zoom. While virtual focus groups were a safe option to continue the study, it presented limitations in data quality and consistency. First, the virtual engagement introduced a potential self-selection bias for technology-enabled participants and those who may have had more space, technology, and time to participate. In regards specifically to youth, the team also recognized that youth who do not have stable home environment may not have had an equal opportunity to participate. Another consideration was that the pandemic may have exacerbated mental health issues and could influence responses. MAPC consulted with its Community Engagement Department to review these factors and identified a set of practices to support the collection of consistent, high-quality qualitative data.

MAPC made a few adjustments in the process to try and accommodate the change in environment. To ensure trauma informed measures were in place, for the in person focus groups, there was a clinician available onsite for focus group participants to talk in the event they might have become upset during the focus group. Similarly, for the virtual focus groups, MAPC had a clinician in a separate Zoom room available for additional help. MAPC also prefaced each focus group by acknowledging the extreme circumstances of the pandemic. These served to establish a sense of camaraderie.

There were data limitations despite efforts taken to ensure that the data collected was consistent and valid. One virtual parent focus group had participants that were not within the target audience (i.e., not a parent of a youth or youth that attempted to access mental health services within the past year). MAPC opted not to code their responses during the analysis process.

Lastly, one virtual youth focus group could not be transcribed due to poor recorded audio and video quality. Therefore, MAPC relied on the detailed notes that were taken by staff who facilitated the group. These notes were incorporated into the findings.