15581-m-nanninga

DETERMINANTS - SYSTEMATIC REVIEW 83 Gaps in knowledge and methodological issues of the included studies Our review shows that literature on determinants of use of care is rather strong, whereas it is rather limited regarding entering and passing through the care system. Evidence was also scarce for potential organizational, professional-related, psychological, and social determinants [45]. Next, a major gap was the large variation in included studies regarding their samples, studied determinants and outcomes. This largely limits the potential to draw conclusions based on the available evidence. Methodological difficulties may explain these gaps, as this concerns rather hard to study topics. However, additional evidence, is needed to understand why certain children and adolescents enter care and others do not. Strengths and limitations Strengths of our review were the use of a comprehensive search strategy with broad search terms in order not to miss any possibly relevant study and the restriction to high quality studies to obtain the strongest evidence. However, our review also had some limitations. We did not search grey literature or literature in languages other than English, and neither did we search through the reference lists of the included studies. It seems unlikely that this would have led to missing any major studies, but we cannot fully exclude this. Finally, use of the Pathways to Care model facilitated structuring the study results [14]. However, other models might better represent enrolment involving multiple pathways rather than a linear one as the model we used suggests [46]. Implications Our review shows that enrolment in and use of care is not only determined by children’s and adolescents’ psychosocial problems but also by other child and family characteristics. This implies that, while having similar problems, the likelihood that a child will enter and receive care is not the same for all children. Professionals and policymakers should be aware that the system of psychosocial care is less accessible for some children, and that these children are hindered in passing through the system. Policies need to be improved to address this. Gaps in evidence in particular concern enrolment and determinants other than child and family socio-demographic characteristics. Longitudinal, high-quality research is needed to fill this gap, in particular regarding organizational, professional-related, psychological, and social determinants. This may highly improve the psychosocial health of children.