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CHAPTER 2 34 DISCUSSION Our community-based study showed that the majority of parents and adolescents expected barriers to child and adolescent psychosocial care. Adolescents expected barriers more frequently than their parents did. The most frequently expected barriers were those with respect to treatment irrelevance, problematic relationship with therapists, and treatment demands. Several child and family characteristics were associated with almost all types of barriers, except for irrelevance of treatment. It was mainly parents with low educational level and their adolescents who expected barriers regarding treatment. Especially for parents of adolescents quite a few characteristics were associated with expecting multiple barriers regarding treatment demands and issues, e.g., single-parents, with lower educational level, parents of male adolescents, and of adolescents with psychosocial problems. Interpretation and fit with other studies To our knowledge, this study is the first that assessed parents’ and adolescents’ expectations of barriers to child and adolescent psychosocial care. Findings on the number and types of expected barriers point in the same direction as the findings for studies on barriers experienced in accessing care, except for one study that showed a much smaller number of perceived barriers [15, 16]. The latter might have been specific to a mainly African-American low-income sample, or might simply imply that expectations and actual experiences of barriers differ. Our study showed that the number of children and adolescents who used psychosocial care in the last 6 months was higher than the number that reported having psychosocial problems. This seems to be in contrast with findings of studies so far [3, 11]. It might suggest that psychosocial problems of children and adolescents are reduced due to successful treatment. However, information about causality is lacking because both problems and psychosocial care use refer to the same time period. The finding might also be explained by the fact that our definition of psychosocial care use is rather broad: we measured any care aimed at reducing or making manageable psychosocial problems of children and adolescents. For example, adolescents mainly use general care for psychosocial problems instead of specialized social or mental health care [29]. It is quite likely that (parents of) some children and adolescents consulted general care providers because of worries about psychosocial issues which are not necessarily scored as problems on the SDQ. Regarding barriers, adolescents expected barriers more frequently than their parents did, a finding which implies that it is worthwhile to assess the expectations of both. This is consistent with evidence showing that parents and their children often