15581-m-nanninga

PROBLEMS AT ENTRY, CARE RECEIVED, OUTCOMES 121 DISCUSSION In general our findings confirm the principles behind the system of psychosocial care for children and adolescents. Children enroled in PCH had mild problems compared to children in CASC and CAMH. In CAMH, relatively many children had internalizing problems, and in CASC relatively many children had externalizing, parenting, family and multiple problems ( child problems and problems related to the child’s context , respectively). Further, care duration was relatively short in PCH and longer in CASC and CAMH. Finally, problems were resolved most often in PCH and among children not in care. These findings confirming the principles of the system are in line with the limited previous findings. First, PCH treats mild problems, and CASC and CAMH more severe problems. This may explain the short care duration and greater problem solution in PCH compared to CASC and CAMH [32,33]. More severe problems – most likely also more complex, more persistent and combined with other problems – can be expected to be more difficult to treat and therefore to require longer treatment [32,33]. Second, our study shows that, compared to CAMH, CASC focuses more on the social and/or economic context of the child, as well as on the child’s problems. This confirms, for example, the available evidence that parental divorce has a stronger association with use of CASC than with use of CAMH [3]. The system thus seems to perform as intended regarding the distribution of problems across care types. Third, children in PCH are much younger than in the other types of care, due to the focus of PCH on primary schools. This younger age may contribute to differences in outcomes. Our study showed that some children enroled in care did not seem to have problems −13%−, and that some children not enroled in care did seem to have problems −35%−; this confirms previous findings [2,34-40]. The first observation − children enroled 'without problems' − might imply that other reasons for enrolment occurred, in particular the existence of a threat of developing problems or other care needs, as in cases of parental divorce with strong conflicts or previous hospitalization [5,32,36]. It is also possible that problems which existed initially were resolved rather quickly, before the SDQ was scored [39]. Finally, the observation might also simply indicate overtreatment [2,34-40]. In any case, the first explanation holds. The second observation − children with problems not enroled in care − may imply undertreatment caused by barriers to access to care, barriers involving problem recognition, help-seeking or referral [30,41-45]. It might be that some of these barriers are resolved later on. This is supported by our finding that 29% of the children not enroled initially contacted a professional, usually the general practitioner, for light psychosocial support after three or after twelve months. An explanation may be that problems are not recognized by the