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.

Background: 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). Methods: A total of 265 caregivers completed the BACE-PR. 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. Results: Caregivers reported care costs as the major barrier to 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. Conclusions: 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.