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

Kotsis, Konstantinos, Thornicroft, Graham, Schafer, Julia Luiza, Serdari, Aspasia, Basta, Maria, Casella, Caio Borba, Marchionatti, Lauro Estivalete, Hoffmann, Mauricio Scopel, Tzotzi, Alexandra, Mitropoulou, Andromachi, Simioni, Andre, Papanikolaou, Katerina, Koumoula, Anastasia and Salum, Giovanni Abrahao (2025) 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. Administration and Policy in Mental Health and Mental Health Services Research, 52 (5). 983 - 998. ISSN 0894-587X

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Abstract

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 who reported that their offspring had mental health difficulties completed the BACE-PR. Descriptive statistics were used to identify the major barriers to accessing care. 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, their willingness to resolve problems on their own, and their own concern that their children might be seen as weak, as the major barriers to services 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.

Item Type:	Article
Additional Information:	© 2025 The Author(s)
Divisions:	Care Policy and Evaluation Centre
Subjects:	R Medicine > RA Public aspects of medicine
Date Deposited:	02 Sep 2025 08:18
Last Modified:	30 Sep 2025 00:01
URI:	http://eprints.lse.ac.uk/id/eprint/129349

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