15581-m-nanninga

GENERAL INTRODUCTION 11 The general aim of this thesis is to enhance understanding of children’s and adolescents’ enrolment in psychosocial care, including the association of enrolment with outcomes of this care. Such increased understanding can be applied in daily practice and policy making, but also in research and education. This chapter places the study in a broader context by providing background information on psychosocial problems of children and adolescents, on psychosocial care, and on the process of care enrolment. The chapter also introduces the academic collaborative centre in which our study took place and the longitudinal prospective cohort study that was set up for this study. This chapter ends with the research questions and an outline of the thesis. Psychosocial problems and their impact Psychosocial problems occur frequently in the general population, and affect an estimated 7 to 24% of children and adolescents [1-6]. Psychosocial problems can be roughly divided into behavioural, emotional and social problems. Behavioural – or externalizing – problems are outwardly visible, for example hyperactivity, aggressiveness and delinquent behaviour. However, emotional – or internalizing – problems, though not always outwardly visible, do affect the child’s emotional state; they include anxiety, depressive feelings, reservedness and psychosomatic complaints [7-9]. Social problems involve difficulties in creating and maintaining relationships with others [10, 11]. Research has consistently shown psychosocial problems to have a major impact on the daily life of children and adolescents, and their families, but also on their future adult lives if problems are not treated effectively. Children with psychosocial problems are more likely to experience less well-being in daily and social functioning, but also poor physical health and educational outcomes [4, 12-16]. Given the relatively high incidence of psychosocial problems among children and adolescents and their serious impact on their current and future lives, it is essential that these children receive timely and effective treatment. Psychosocial care for children and adolescents Children, adolescents and their families can receive psychosocial care from various types of care providers, including as major types preventive child healthcare (PCH), child and adolescent social care (CASC), and child and adolescent mental healthcare (CAMH), see Table 1 [4, 17-20]. In PCH doctors and nurses provide care to children and families with mild child and family problems. In case of more severe problems, PCH refers children and families to specialized care, either CASC or CAMH. In CASC child (social) workers provide care for children with psychosocial problems, as well as for children with social and economic problems within the family that could impede or threaten the child’s