15581-m-nanninga

PROBLEMS AT ENTRY, CARE RECEIVED, OUTCOMES 123 as with their two biological parents, with parents with relatively higher educational levels, and more often off Dutch origin (for comparable findings, see [41,55,56]). These findings on outcomes might also be seen to suggest that treatment is, on average, only to some extent effective, with some children and/or parents reaping more benefit than others [1,50]. Insight into the impact of care on other outcomes, such as coping with problems, could lead to a better understanding of this issue. Strengths and limitations This study has considerable strengths. First, we were able to make longitudinal comparisons between children and adolescents enroled in care and those not enroled, with high retention and in a large sample. Second, we were able to include all children and adolescents in a well-defined catchment area, providing an inclusive overview of all types of psychosocial care. Our study also had some limitations. First, we had a considerable non-response upon entry. However, differences between respondents and non-respondents were small, decreasing the likelihood of selection bias [8]. Second, the observational nature of this study limits its potential causal inferences on outcomes of care. Third, although we included both parents and adolescents reported data, we did not have adolescents’ reports for some problem domains, such as for parenting and family problems. Implications Our study provides a first sketch of the association between problems upon enrolment, care types, and outcomes. Essentially, we found that the system of psychosocial care seems to perform as intended regarding the distribution of problems across care types. Our findings also suggest several starting points for improvement of the system, e.g. regarding (1) children enroled in care without problems and children not enroled in care with problems, (2) overlap in outcomes between care types, and (3) only partial solution of problems. The first issue has to do with improving the process of enrolment in care. We particularly need to disentangle the reasons why some children without problems enrol in care, and others with problems do not, to show whether or not this is a desired situation. A related issue is to further disentangle why adolescents in the non- enroled group scored higher on psychosocial problems compared to their parents, and why this was the opposite in the enroled group, and whether this difference is related to the process of enrolment in care. The second issue, overlap in outcomes, calls for further research on the specific interventions offered in each type of care to assess whether or not the type of care