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CHAPTER 7 134 In Chapter 5 we built upon our review by examining potential determinants other than demographic characteristics. We showed that the child’s social environment, more specifically family social support and parenting, plays a role in its psychosocial care enrolment. Low family social support and poor parenting were associated with psychosocial care enrolment, factors also associated with more frequent occurrence of children’s psychosocial problems. This gives some insight into why the social environment is important for enrolment. Low family social support was associated with psychosocial care enrolment both directly and indirectly via the child’s psychosocial problems. The mechanism may be that social support is a protective factor that buffers the impact of children’s psychosocial problems, or in some cases even prevents problems [17]. This is in line with the ‘Balance model’, showing that child psychosocial problems do not necessarily lead to consequences for the child or the family when other factors function as protective factors [18, 19]. The mechanism behind the direct negative association of family support with enrolment in care might be that a need for professional care originates to a significant extent with problems in the family and is not based only on problems of the child. This is confirmed by our findings in Chapter 6 that children – and families -- with family problems frequently enrol in care [20]. We cannot be conclusive about the direction of the associations between social support and parenting on the one hand and enrolment in care on the other hand, because this part of our study was cross-sectional. It might be that the family is receiving less social support because the child and the family are involved in psychosocial care, for example because of the stigma attached to having psychosocial problems [21, 22]. More specifically, regarding poor parenting we found that poorly supervised children and children exposed to inconsistent discipline were more likely to have psychosocial problems. Good parenting skills might also function as a protective factor to prevent the development of psychosocial problems [23]. This confirms the importance of parenting support in the (early) treatment of child psychosocial problems [15]. These findings on parenting are also in line with those described in Chapter 6, which showed that children from families with parenting problems often enrol in psychosocial care. We further extended our review by obtaining more insight in the factors and mechanisms that play a role in children´s and adolescents’ enrolment in psychosocial care. In particular, we examined expectations regarding barriers to psychosocial care. To our knowledge, we are the first to assess these expectations in the community. Earlier research on barriers in psychosocial care for children and adolescents was specifically based either on clinical samples [24-30], or on barriers experienced during treatment [12, 31, 32]. We developed the Barriers to Treatment Participation Scale- Expectancies (BTPS-Exp), a prospective questionnaire on potential barriers to children’s