Language access for immigrants in pediatric mental health care – a systems thinking approach

Introduction

Pediatric mental health services in regions with a large number of immigrant members with Language Preferences other than English often face challenges related to language access and can hinder effective communication among providers, youth, families, and interpreters. We present the methods and findings from a systems thinking exercise from Baltimore, USA, which mapped the complexities of language access from multiple perspectives to identify and address challenges.

Methods

A group model building workshop was conducted in April 2025 with ∼20 therapists, interpreters, and family representatives. Participants engaged in activities designed to identify and prioritize challenges, understand the relationships between barriers and facilitators, and hypothesize potential intervention areas. A causal loop diagram was developed and refined after the workshop to visually represent the system of interest and entry points for interventions. Qualitative data from focus group discussions informed this process.

Results

Through facilitated discussions, participants identified key barriers and facilitators, resulting in a preliminary map of relationships between family and health care delivery systems. We identified multiple feedback loops and interdependencies among interpreter-related aspects and both clinicians and patients. The insights derived highlight the central role of interpreters in the development and sustainment of the therapeutic alliance between providers and families.

Conclusions

Our systems approach shed light on ideas for quality improvement and operations research, such as developing system dynamics simulations for policy analysis, and for conducting scenario building for potential interventions to improve care delivery in multilingual settings. Given demographic shifts and increasing linguistic diversity across the EU these findings offer timely guidance for strengthening equitable, culturally responsive mental health services.

Key messages

• Language access is a system-level barrier in pediatric mental health care for immigrant families—effective communication depends on coordinated workflows among clinicians, patients, and interpreters.

• Systems thinking reveals feedback loops display the critical role of interpreters in the therapeutic alliance; these insights can guide quality improvement to strengthen equitable multilingual care.