Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Marriage and Family Therapy


Linda Stone Fish


behavioral health, collaborative health care, Consumers' experiences, Federally Qualified Health Center, mental health, phenomenology

Subject Categories

Family, Life Course, and Society


Research indicates that living in poverty exacerbates the risk for poor mental health, yet low-income people are less likely to seek mental health treatment than are people in higher income brackets. The research literature reports that this reluctance to seek behavioral health care is often due to a variety of barriers, such as stigma, costs, victimization, discrimination, and labeling. Federally Qualified Health Centers (FQHCs) are collaborative healthcare clinics that are uniquely positioned to eliminate many recognized barriers to care that hinder access to mental health services for some vulnerable and underserved populations. Most of the collaborative health care literature is reported from the perspectives of healthcare professionals and administrators, while consumers' viewpoints are vastly underrepresented and unexplored. This study helped to address this research gap.

The purpose of this qualitative study was to understand perceptions and experiences of clients utilizing behavioral health services within a collaborative healthcare FQHC. Using a phenomenological methodology, this study explored the real-lived experiences of 11 low-income clients who voluntarily participated in individual interviews. Using data analysis procedures recommended by Moustakas (1994), the participants' interviews were examined and went through multiple levels of abstraction to explore the deeper meanings of their experiences. Data analysis suggested that the participants' positive and caring relationships established with their therapists had a profound impact on their behavioral health experiences. Through the trusting relationships established with their therapists, participants felt safe to engage in the therapeutic process and work towards change. Participants described their behavioral health experiences as being a safe-haven that helped them achieve personal growth and better self-understanding.

Relationships with the health center's staff and the environment of care at the FQHC were additionally acknowledged as having a meaningful impact on the participants' experiences of care received. The collaborative health care relationship also surfaced as an indispensible resource in breaking barriers to mental health treatment, and thus, increased the likelihood for consumers to utilize behavioral health services. The results of the study support much of the literature pertaining to the effectiveness of the collaborative health care approach and have clinical implications for Marriage and Family Therapists and other healthcare professionals


Open Access