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GENERAL DISCUSSION 133 and between those in care and not in care. Reductions in problem rates were also substantial among children not in care. DISCUSSION OF MAIN FINDINGS Determinants of enrolment in psychosocial care A major part of this thesis deals with enrolment of children and adolescents in psychosocial care. First, this regards the existing evidence on determinants, i.e. the main body of research regarding enrolment in and use of care. In our systematic review (Chapter 4) we identified a set of child and family characteristics associated with passing through different stages of the enrolment process and with actual use of care; these stages have been defined by Goldberg and Huxley’s Pathways to Care model [1]. The characteristics that we identified were diverse, mainly regarding sociodemographic characteristics, and for some characteristics findings were heterogeneous, i.e. the direction of the associations varied between studies. A large variation in the designs of the included studies, specifically regarding samples, studied determinants and outcomes, limited the potential to draw clear-cut conclusions. Nevertheless, the review revealed that enrolment in psychosocial care involves more factors than just the level and nature of the child’s psychosocial problems. One gap revealed by the review was a scarcity of evidence for factors other than sociodemographic characteristics, such as organizational, profession-related, and client-related psychological and social determinants. Also, most studies focused on use of care, and only few on determinants of the different stages of the enrolment process, i.e. of entering and passing through the care system. Although we found that having psychosocial problems is a determinant of enrolment in psychosocial care (Chapter 4), our study also showed that some children and adolescents (13%) enroled in care did not seem to have problems (Chapter 5). We further found that some children and adolescents (35%) not enroled in care did seem to have problems. These findings confirm previous findings[2-9]. As mentioned in Chapter 5, children enroled ‘without problems’ might suggest other reasons for enrolment, like the threat of child problems due to unhealthy family situations or a rather quick problem resolvement [5, 8, 10, 11]. It could also imply overtreatment[2-9]. The finding of children and adolescents with problems not enroled in care, may be explained by undertreatment caused by barriers involving problem recognition, help-seeking or referral [12-14]. On the other hand, these children might either be able to cope with their problems, or not really consider their problems as problematic [4, 5, 15, 16].