15581-m-nanninga

EXPECTATIONS OF BARRIERS 27 Measures Parents’ and adolescents’ expectations of barriers to care were measured using the Barriers to Treatment Participation Scale-Expectancies (BTPS-exp) [17, 33], translated into Dutch following the Guillemin translation procedure [34]. Parents and adolescents were asked to “imagine that you are seeking psychological help, counselling, or advice [for your child]” and asked to indicate to what extent they agreed with the items, with answer categories ranging from “totally disagree” to “totally agree” (five-point Likert scale; 44 items in the parent version, 43 items in the adolescent version). An expected barrier was coded as occurring when rated with “somewhat agree” or “totally agree” in order to calculate the total number of expected barriers. In addition, we calculated mean scores for the total scale and for each of the subscales:  Stressors and obstacles competing with treatment , i.e., problems regarding transport, other children at home, activities, health, or conflict with a significant other about coming to treatment (parent and adolescent versions 20 and 19 items, respectively)  Treatment demands and issues , i.e., concerns about treatment cost and duration, having a voice in treatment, confusing information (10 items)  Perceived irrelevance of treatment , i.e., concerns about the need for and relevance of treatment, about treatment introducing new or other problems (8 items)  Problematic relationship with therapist , i.e., concerns about not having a good relationship with the therapist, not receiving enough support (6 items). Internal consistencies of the total scale and subscales of the parent and adolescent versions were good (lowest Cronbach α=.83). Child characteristics Relevant child characteristics included age, gender, ethnicity, psychosocial problems, and past psychosocial care use. Ethnicity was defined as either Dutch or non-Dutch (i.e., the child and/or one of the parents was foreign-born). Children’s psychosocial problems were measured using the total difficulties score of the “Strengths and Difficulties Questionnaire” (SDQ-TDS), based on the past 6 months (Cronbach’s α parent version = .80; adolescent version = .72) [31, 35-37]. The score consists of 20 items describing positive and negative attributes of children on the following dimensions: emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems. The scale was dichotomized into the “normal” and the “borderline to abnormal” range of the SDQ. Psychosocial care use in past 6 months was measured using the “Questionnaire Intensive Care for Youth” [38-40]. We asked parents and adolescents to indicate among