15581-m-nanninga

CHAPTER 7 132 Twenty-two studies met our inclusion criteria and were methodologically strong. Care enrolment and use were determined not only by children’s psychosocial problems but also by other child and family characteristics. The main child factors enhancing the likelihood of enrolment in and use of care were having psychosocial problems, urban area residence, life events, past treatment, and academic problems. We found varying effects for age, gender, ethnicity, and place of residence. Main family factors identified contributing to increased enrolment in and use of care were being a single-parent family and socioeconomic status (varying effects). The fourth research question (Chapter 5) was: Are family social support and parenting skills, two key aspects of the child’s social environment, associated with children’s and adolescents’ enrolment in psychosocial care? And, if so, what role do children’s psychosocial problems play in these associations? We found that enrolment in psychosocial care was more likely in cases of low family social support and poor parenting skills, i.e. poor supervision and inconsistent disciplining. Children’s psychosocial problems partially mediated the associations with family social support and completely mediated the associations with parenting skills, but did not moderate the associations. This means, for example, that children of families with low family social support were more likely to have psychosocial problems, and that these problems in turn made enrolment in psychosocial care more likely. Positive parenting was not associated with care enrolment. The fifth research question (Chapter 6) was: Are the types of problems upon enrolment, i.e. child, parenting and family problems, associated with enrolment in different types of psychosocial care? And do care types differ in outcomes (of care duration and problem solution) after three and twelve months? We found that the system of psychosocial care functions as intended regarding the distribution of problems across care types. Enroled children had more problems, among which also more often multiple problems, than children not enroled in care. In child and adolescent mental healthcare (CAMH), relatively many children had internalizing problems, and in child and adolescent social care (CASC) relatively many children had externalizing, parenting, family and multiple problems. Regardless of the type of problem, care duration in preventive child healthcare (PCH) was relatively short; in CASC and CAMH it was longer. Reductions in problem rates were substantial but by far not complete: 35 to 62% after twelve months, and relatively higher in PCH. Specifically, for internalizing and parenting problems, the decrease in problem severity was greatest among children in PCH. For externalizing and family problems we found no significant differences on outcomes after twelve months between children in different care types,