15581-m-nanninga

PROBLEMS AT ENTRY, CARE RECEIVED, OUTCOMES 109 INTRODUCTION Children and their families enrol in psychosocial care because of various child and family problems [1,2]. However, evidence is lacking as to which types of problems are presented to which types of psychosocial care, even though the idea behind the system of psychosocial care would seem self-evident [3]. Evidence is also lacking as to whether care outcomes vary depending on the alignment of type of problems with type of psychosocial care. Such knowledge is needed to optimize the access of children and adolescents to psychosocial care, to deliver care that is need-oriented, and to improve care outcomes [4- 7]. Systems for psychosocial care have been designed so that specific care types focus on specific child and family problems, depending on levels of problem severity and co- occurrence of problems in the social and/or economic context of the child [8-10]. For example, in the Netherlands, preventive child healthcare (PCH) focuses on mild child and family problems, referring children and families with more severe problems. Specialized child and adolescent mental healthcare (CAMH) provides care for children with more severe psychosocial problems and psychiatric disorders. Child and adolescent social care (CASC), in addition to dealing with children’s psychosocial problems, focuses on problems in the social and economic context that could impede or threaten the child’s development, problems such as poor parenting and unhealthy family functioning [3,8]. Types of psychosocial care have thus been delineated by design, but there is insufficient evidence as to whether this delineation is realized in practice. The few available studies suggest at least some overlap in the types of problems addressed by the various care types. However, these previous studies have addressed only the child’s problems, without considering problems in their social and economic context [3,11-14]. Moreover, there is little evidence on the effectiveness of the design itself: which problems could best be referred to which types of psychosocial care. The aim of our study was thus to assess the types and severity of problems upon enrolment in psychosocial care, i.e. child, parenting and family problems, and compare these to problems of children and adolescents not enroled in psychosocial care. Next, we assessed outcomes, i.e. care duration and problem solution, after three and twelve months.