15581-m-nanninga

SOCIAL SUPPORT AND PARENTING SKILLS 89 INTRODUCTION Approximately 10-25% of children and adolescents have emotional or behavioural problems [1-5]. Recent studies have shown that only a proportion of the children up to 18 years of age with emotional or behavioural problems receive psychosocial care [3, 6-12]. For example, a recent Dutch study showed that only 29% of the adolescents in need of care actually received psychosocial care [13]. These findings might imply that enrolment in psychosocial care depends not only on the degree to which a child suffers from emotional or behavioural problems, but also on other factors. Knowledge of the determinants of children’s enrolment in psychosocial care in particular concerns socio-demographic factors and severity of psychosocial problems, but is lacking regarding other child, parent and family factors. Recent studies show that psychosocial care enrolment is more likely for children of white/Caucasian ethnicity, residence in an urban area, with health insurance, older children and children of families with a single parent and a higher socio-economic status [1,14-25]. Child gender seems to be of importance as well but its effect varies across studies. Knowledge is limited to single types of care [1,8,11,15,25,26] and does not cover psychological and social factors. However, the social environment is likely to be a key determinant of care enrolment in the event of problems [27,28]. Certain factors in the child’s social environment act as resources of the family to cope with psychosocial problems of the child, for example family social support and parenting skills [29]. Both the lack of family social support and of good parenting skills may impede the family to manage the child’s problems appropriately. The resulting difficulties may urge the family to seek and use psychosocial care [29]. However, evidence on the associations between family social support and parenting skills with psychosocial care enrolment is scarce and inconclusive. Regarding family social support the limited evidence showed a neutral, positive or negative association with care enrolment [26, 29-32]. The direct association between parenting skills and care enrolment has not been studied before as far as we know. However, it is known that children of parents with poor parenting skills are at risk of developing psychosocial problems [3, 33-35]. This might mean that parenting skills, and potentially also family social support, are associated with enrolment in psychosocial care only if the child has psychosocial problems. Another possibility is that parenting skills and family social support are indirectly associated with care enrolment through their effects on the child’s psychosocial problems. In order to fill the gaps in knowledge, we, therefore, examined the associations between family social network support and parenting skills on the one hand and, on the other hand, children’s enrolment in psychosocial care. We also examined the role of