Hester van Eeren

| Chapter 1 1 | 8 Youth care is aimed at improving the well-being of children and adolescents and their parents. Moreover, youth care aims to prevent society from the burden of misbehavior and crime due to behavioral problems. Given these aims and the importance of them to society, substantial budgets are available for youth care in the Netherlands. To spend these budgets wisely, it would be worthwhile to be able to justify the reimbursement of youth care interventions based on cost-effectiveness data. Such information, however, is scarce because methods of cost-effectiveness analyses in youth care are not fully developed and data needed for such studies are difficult to obtain. As a result, little is known about the (cost-) effectiveness of most of the available youth care interventions. Therefore, this thesis aims at contributing to the development of research tools to determine the effectiveness and cost-effectiveness of interventions in youth care. Dutch youth care The Dutch youth care system comprises a broad range of interventions. To get an impression of the available interventions, the ‘database effective youth interventions’ can be consulted (DEI; ‘databank effectieve jeugdinterventies’ in Dutch; Netherlands Youth Institute, 2016a). The DEI provides insight into the quality, feasibility, and effectiveness of interventions and aims to connect academic research and theories with youth care practice (Netherlands Youth Institute, 2016b). The underlying thought is that practice- based evidence can lead to evidence-based practice to improve the services rendered to children, adolescents, and their parents (Veerman, van Yperen, Bijl, Ooms, & Roosma, 2008). According to APA standards, evidence-based practice is “the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences” (APA Presidential Task Force on Evidence-based practice, 2006, p. 273). This definition underscores the aim of the DEI to be transparent about the available evidence for each youth care intervention. The effectiveness of interventions in the DEI is ranked according to the so-called ‘effectladder’ that comprises four categories of evidence: the intervention has potential (i.e., is well described), is promising (i.e., has a good underlying program theory), is effective in daily clinical practice (i.e., shows first signs of effectiveness based on, for example, routine outcome monitoring), or the intervention is effective based on a research design with an experimental and a control condition (Veerman & van Yperen, 2008). The higher the level of evidence, the more proof that the outcomes found after finishing an intervention indeed resulted from the intervention itself and were not caused by confounding factors (Veerman & van Yperen, 2008). Various committees consisting of clinicians and scientists with a specific area of expertise rank submitted interventions on their level of effectiveness (Netherlands Youth Institute, 2016c). Gathering available evidence and structuring it for all youth care interventions in the DEI supports clinicians, youths and families, but also policy makers in weighing the pros and cons of the interventions offered and, thus, making well-informed choices.