15581-m-nanninga

CHAPTER 1 14 and the Gateway Provider model [28], focus mainly on determinants, defined as multiple influences dynamically affecting attitudes towards and actual use of care. Goldberg and Huxley describe enrolment in psychosocial care as a process with various stages of intensity. These stages concern various levels of care, starting with the recognition of children's needs, and ranging from community-based to inpatient care. The levels are separated by filters through which children and their families must pass in order to reach a more specialized level of care: (filter 1) the decision to consult a professional/seek help, (filter 2) the recognition of psychosocial problems by a professional, (filter 3) referral to specialized outpatient care, and (filter 4) admission to inpatient care. Based on this model we define psychosocial care enrolment as either entering the care system by passing the first filter, or moving through the care system by passing one of the subsequent filters to more specialized care. The Pathways to Care model is presented in Figure 1 of Chapter 4. The need for more insight on children’s enrolment in psychosocial care is repeatedly underlined by the repeated finding that only a minority, an estimated 23-38%, of children and adolescents with psychosocial problems enrol in psychosocial care [9, 29-34]. Following the Pathways to Care model, our study will therefore first explore the views of children and parents in the community regarding barriers to psychosocial care. Community-based evidence on this subject is scarce, although children ’ s and parents’ views on barriers very likely affect seeking care and the use of care [25-27, 35]. We will assess the number of barriers expected, the types of barriers most expected, and the associated child and family characteristics. Especially the latter may provide direction to improve the process of enrolment for children and adolescents. As part of this research, we will assess the psychometric properties of the scale we have developed and used to assess expectations regarding barriers to care: the Barriers to Treatment Participation Scale-Expectancies (BTPS-exp). The BTPS-exp can be used both among adolescents and parents in the community and among those at the start of psychosocial care. We will further obtain insights into enrolment by assessing determinants of children’s and adolescents’ enrolment in and use of psychosocial care. Evidence indicates that factors other than psychosocial problems are also important determinants of enrolment, for example certain child and family background characteristics [27, 28, 32, 36]. We will perform a systematic review on this topic, because in spite of extensive available evidence on enrolment and use of care, recent literature reviews are lacking. Results of our review provide a basis to further explore the effect on psychosocial care enrolment of a child’s social environment, especially social support and parenting skills within the family.