Date of Award

Summer 8-5-2022

Degree Type


Degree Name

Doctor of Social Work (DSW)

First Advisor


Second Advisor



Parental “Sense of Agency”: A Qualitative Study of Parents Experiences Assisting their Children in Outpatient Community Mental Health Treatment.


In the United States, there are approximately 17 million children under the age of 17 that have commonly diagnosed mental health disorders which include ADHD, behavior problems, anxiety, and depression (Bitsko et al., 2019). In efforts to provide access to mental health treatment, there are approximately 11,682 mental health facilities as of 2018, 62% of which are comprised of community mental health centers and outpatient mental health clinics that provide mental health services for children and families (SAMSHA, 2018).

The purpose of this qualitative phenomenological study is to explore the experiences of parents and/or primary caregivers “sense of agency” in reference to working with mental health professionals in outpatient community mental health settings. For the purposes of this study, “sense of agency” is defined as actions that are experienced as voluntary and in which we may not feel as simply happening to us rather, we experience agency when we are in control of our actions (Synofzik et al., 2008; Moore, 2016). The assumption in the study is that parents “sense of agency” is a critical aspect of parents being able to effectively engage and implement evidenced based interventions utilized for their children in outpatient community mental health settings. Furthermore, parents increased or improved “sense of agency” would have a lasting impact on their ability to assist their children with mental health conditions even after their children are no longer receiving mental health treatment. The theoretical framework that was utilized in the study to explore parents “sense of agency” was Bowen’s Family Systems Theory.

The study was comprised of N=10 participants who had one or more children participating in one outpatient clinic in Central Harlem. Parents engaged in a one-hour semi-structured interview which explored their experiences assisting their children in mental health treatment and their interactions with their child, mental health practitioners and other supports. After the study was completed, four major themes emerged. The four themes included: parents locus of control, parental activation, parental attributions, and issues related to the utilization of psychotropic medication by some of the children in the study. These themes impacted parents “sense of agency” in how they were able to engage in their child’s treatment, what they believed were potential causes of their child’s mental health condition, their orientation of control (whether external or internal) in reference to their child’s progress in treatment, as well as, navigating their children’s resistance to psychotropic medication.

Social work practice implications would incorporate interventions that can increase parents “sense of agency”, specifically due to its relational nature which may lead to a transmission of agency to future generations considering the ongoing systemic challenges that families may face in their own communities. The implications for future studies may focus not only on parents “sense of agency” during their child’s mental health treatment but parents “sense of agency” before the start of their child’s treatment process in relation to their capacity to implement interventions that are formulated alongside the mental health practitioner.

Furthermore, studies may seek to follow up with parents after their child’s completion of treatment in efforts to understand parents’ experiences or changes in their “sense of agency” as it relates to their children’s mental health. These studies would further allow to improve the understanding between parents “sense of agency” and long-term outcomes in mental health treatment for their children.

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Social Work Commons