15581-m-nanninga

BTPS-EXP 45 INTRODUCTION Children and adolescents with emotional and behavioural problems constitute approximately 7-24% of the total child population [1-5]. Timely and adequate intervention may prevent them from experiencing adverse consequences of psychosocial problems, such as current and future difficulties in daily functioning [3, 6-8]. Only a minority, estimated as 23-38%, actually receive psychosocial care [6, 7, 9-13]. Barriers to care may be the main reason why not all of these children receive care. Estimates are that 35-61% of the parents experience barriers when accessing psychosocial care for their child [14, 15]. In addition to barriers actually experienced when accessing care, parents’ and children’s expectations regarding such barriers may also play a critical role in seeking and utilizing psychosocial care for the child. In a review, Morrisey-Kane and Prinz concluded that positive expectations towards care, such as the expectation that the child’s behaviour is changeable or that treatment is effective, were of major importance for successful help-seeking and treatment of children’s psychosocial problems [16]. The importance of expectations regarding barriers is also stressed in Andersen’s health behaviour model , in which expectations of barriers – as part of the beliefs patients hold – determine patients’ need perception and their utilization of health services [17-19]. To date, there are no reliable or valid measures available to assess expectations regarding barriers. This greatly limits the elaboration and the eventual remedying of barriers that prevent many parents and children from entering care and from participating in treatment after intake. The present study has evaluated a measure referred to as the “Barriers to Treatment Participation Scale-Expectancies” (BTPS-exp). The BTPS-exp is a modification of the “Barriers to Treatment Participation Scale” (BTPS), developed and validated by Kazdin and colleagues to measure actual barriers experienced during children’s treatment [20]. In the questionnaire, parents are instructed to imagine that they are seeking psychological help, counselling, or advice for the child [21]. The scale reflects both logistical and belief-based expectations of barriers by means of 44 items divided over four subscales: “stressors and obstacles that compete with treatment,” “treatment demands and issues,” “perceived irrelevance of treatment,” and “problematic relationship with the therapist” [14, 20, 22]. The original retrospective BTPS items have been modified to prospective items. A prospective version enables to obtain insights into the opinions of parents and children in the community, during the various stages of the help-seeking process and the beginning of treatment. To address expectations at the beginning of treatment, use of a prospective version is critically important to prevent potential confounding by the degree of success in the treatment later on, e.g. substantial symptom improvement