15581-m-nanninga

DETERMINANTS - SYSTEMATIC REVIEW 67 INTRODUCTION Approximately 7-24% of children and adolescents experience mild to serious emotional or behavioural problems [1-5]. Psychosocial care for them and their families, is provided through a range of services, of which the main ones are: primary care, child and youth social care, and child and youth mental health care. Despite the wide range of services, only a minority of children and adolescents with psychosocial problems receives care [3, 6-13]. Identification of the determinants of children’s enrolment in and use of psychosocial care is needed to improve children’s access to services. Goldberg and Huxley’s Pathways to Care model provides a useful basis for structuring determinants of enrolment in and use of psychosocial care by children and adolescents [9, 14-16]. Where other models such as the Health Behaviour model and the Gateway Provider model have their focus on determinants , i.e. multiple influences dynamically affecting attitudes towards and actual use of care [17-19], the Pathways to Care models has its focus on the process of enrolment. This provides a good starting point to define care enrolment. The Pathways to Care model postulates that children enter the system of care by passing filters in order to reach more specialized levels of care (Figure 1). The filters that separate the levels comprise (1) the decision to consult a professional/seek help, (2) the recognition of psychosocial problems by a professional, (3) the referral to specialized outpatient care, and (4) the admission to inpatient care. Enrolment is defined 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. An up-to-date comprehensive literature review concerning the determinants of enrolment in psychosocial care for children and adolescents is lacking. Reviews on this topic concern those of Zwaanswijk and colleagues –literature up to 2001–,of Sayal – literature up to 2003–, and of Ryan et al – literature up to 2013- but these do not provide a full overview of the determinants of entering and the use of the broad field of psychosocial care for children and adolescents [9, 15, 20]. These reviews concerned only a limited range of care, regarded moving into and through only some filters of the Pathways to Care model [9, 20], or they only involved younger children [15]. Moreover, they defined enrolment in care differently by including parental recognition of problems [9, 15]. Finally, they did not differentiate between studies on help seeking and studies on use of care [9]. The aim of our study was to systematically summarize the available literature on the determinants of enrolment in and use of psychosocial care for children aged 0-18 years, according to the filters of the Pathways to Care model [14]. Our review covers all types of care aimed at reducing or making manageable psychosocial problems of both children