15581-m-nanninga

EXPECTATIONS OF BARRIERS 25 INTRODUCTION Only a minority of the children and adolescents with emotional or behavioural problems receive psychosocial care [1-12]. For example, a recent study showed that, of the adolescents in need of psychosocial care, only 29% actually received that care [11]. One of the causes may be the barriers to care that parents and children expect or have experienced [13, 14]. According to Owens and colleagues, barriers to care comprise those “factors that have prevented access or created difficulties in accessing child mental health services” (p.731) [15]. Between 35-61% of parents with a child suffering from psychosocial problems experience barriers to care [15, 16]. These barriers can be structural – financial, for example – but can also relate to perceptions of care or psychosocial problems: the prospect of encountering inadequate care providers or the expectation that problems will improve by themselves, for example [15, 17]. Most evidence about barriers to care is based on clinical samples, i.e., children and adolescents with psychosocial problems either in need of or using psychosocial care [15- 21]. This evidence shows that the barriers experienced by those in need have been shown to be associated with a lower intention of seeking help [18], along with a lower likelihood of using psychosocial care [19-21]. Barriers experienced by parents during their child’s treatment have been shown to be associated with poor care outcomes: higher dropout rates, less symptom improvement, and less treatment acceptance by the child and parent [17, 22, 23]. To our knowledge, community-based evidence is lacking in terms of expectations that children, adolescents, and parents have about barriers to children’s psychosocial care. These expectations are likely to influence care seeking and use. For example, according to Andersen’s Health Behaviour Model , expectations regarding health care are among the determinants for patients’ utilization of care [24-26]. Furthermore, the review of Morrisey-Kane and Prinz concluded that positive parental expectations towards care are of importance for successful help seeking and engagement in treatment [14]. The aim of our study was to examine in a community sample of children and adolescents: (1) the number of barriers that parents and adolescents expect when considering seeking psychosocial care for their child or for themselves, respectively; (2) the type of barriers expected most frequently; and (3) the child and family characteristics associated with these expectations. In this study, psychosocial care is defined as all care aimed at reducing or making manageable psychosocial problems of children and adolescents [27]. In the Netherlands, like in many other countries, this is provided by preventive child health care, child and adolescent social care, and mental health care [28-