15581-m-nanninga

GENERAL DISCUSSION 137 more severe psychosocial problems and psychiatric disorders, and CASC focuses on problems in the social context of the child that could impede or threaten the child’s development, and on treatment of children’s psychosocial problems. These problems in the social context include poor parenting and unhealthy family functioning [45, 48]. In short, the second assumption concerns the distribution of problem types among care types. The first assumption, regarding the distribution of problem severity across the care types, is generally confirmed by our findings. We found that PCH treats mild problems and provides short-term care. In addition, we found that CASC and CAMH treat more severe problems and provide longer treatment [49,50]. Regarding the care outcomes of PCH, CASC and CAMH in relation to this first assumption, we found that in PCH problems are resolved for many children and adolescents. This might simply be because children and families with mild problems – mainly enroled in PCH − have problems that are easier to treat; children with more complex problems mainly enroled in CASC and CAMH. However, these findings may also ‘simply’ reflect a good fit between needs and the care offered. Complex problems are more persistent and, as shown by our data, more often combined with other problems which are being treated mainly in CASC and CAMH [51, 52]. Regarding the second assumption, our findings confirm to some extent the assumption behind the system of distribution of problem types across care types. We found that relatively many children enroled in CASC had problems related to their social environment such as externalizing, parenting, and family problems, whereas relatively many children with internalizing problems enroled in CAMH. However, the differences were small; children and adolescents with externalizing, parenting and family problems were also enroled and treated in CAMH and children with internalizing problems were also enroled in CASC. It might be that over time, the various care types of CASC and CAMH have gradually come to overlap and include parts of each other’s approach. On the other hand, the strong mutual impact, i.e. adverse social and economic circumstances lead to psychosocial problems and vice versa, might impede differentiation of the problems of a majority of the clients [45,48]. Our findings on outcomes also showed rather similar degrees of problem solution and decreases in problem severity between CASC and CAMH, especially for internalizing and parenting problems. It seems that both care types aim at problem solution for every type of psychosocial problem of children, adolescents and their families. We further found that the percentage of resolved problems varied between 35% (for internalizing problems and CAMH after twelve months) and 62% (for parenting problems in PCH after twelve months). Also, decreases in severity of problems after