Introduction
Methods
Study design
Sample and procedure
Care type | Description |
---|---|
Preventive child healthcare (PCH) | In PCH, doctors and nurses provide care to children and families with mild child and family problems. In case of more severe problems, PCH may refer children and families to specialized care, either CASC or CAMH PCH provides light psychosocial support, for example family support on an ambulatory/outpatient or home-based basis. Care aims to be short Children and families mainly enter PCH by visiting the school doctor or nurse who is employed in PCH. Enrolment via referral of their general practitioner or via the youth care office (in Dutch: ‘Bureaus Jeugdzorg’) is also possible Municipalities finance PCH |
Child and adolescent social care (CASC) | In CASC, child (social) workers and pedagogues provide specialized care to children and families. CASC treats psychosocial problems and problems in the social and economic context that impede or might threaten the child’s development, such as parental or family problems. Compared to PCH, CASC treats more severe problems CASC provides individual child support, trauma support, experiential learning support, independent living support, parenting and family support and foster care support. Care includes ambulatory/outpatient, home-based, day treatment, residential care or family foster care. More frequently than in PCH, care lasts longer than 3 months Children and families enter CASC mainly via referral by the youth care office. The youth care office also decides about the type of interventions that needs to be offered. Referral to CASC by PCH or the general practitioner is also possible Provincial governments finance CASC |
Child and adolescent mental healthcare (CAMH) | In CAMH psychologists and psychiatrists provide specialized care to children and families. CAMH treats psychosocial problems and psychiatric disorders. Compared to PCH, CAMH treats more severe problems CAMH provides individual child support, trauma support, parenting and family support. Care is ambulatory/outpatient, home-based or day-treatment. More frequently than in PCH, care lasts longer than 3 months Children and families enter CAMH mainly via referral by the general practitioner. Referral via PCH or the youth care offices is also possible Health insurance companies finance CAMH |
Measures
Analyses
Results
Participants’ characteristics
Characteristics | Enrolled in psychosocial care (care cohort) | Not enrolled in psychosocial care (reference cohort) | ||
---|---|---|---|---|
N = 1382a
|
N = 443a
| |||
N
| (%) |
N
| (%) | |
Child characteristics | ||||
Age | ||||
4–11 years (i.e. primary school age) | 828 | (60.1) | 268 | (60.5) |
12–19 years (i.e. secondary school age and older) | 550 | (39.9) | 175 | (39.5) |
Gender | ||||
Male | 734 | (53.3) | 184 | (41.5) |
Female | 644 | (46.7) | 259 | (58.5) |
Ethnicity | ||||
Dutch | 1098 | (84.6) | 395 | (93.4) |
Non-Dutch | 200 | (15.4) | 28 | (6.6) |
Internalizing problems (parent report) | ||||
Normal | 468 | (35.2) | 384 | (88.9) |
Borderline/abnormal | 863 | (64.8) | 48 | (11.1) |
Internalizing problems (adolescent report) | ||||
Normal | 227 | (50.1) | 135 | (82.3) |
Borderline/abnormal | 226 | (49.9) | 29 | (17.7) |
Externalizing problems (parent report) | ||||
Normal | 675 | (50.7) | 413 | (95.6) |
Borderline/abnormal | 656 | (49.3) | 19 | (4.4) |
Externalizing problems (adolescent report) | ||||
Normal | 263 | (58.1) | 143 | (87.2) |
Borderline/abnormal | 190 | (41.9) | 21 | (12.8) |
Psychosocial care use in past six months | ||||
No | 224 | (16.3) | 443 | (100.0) |
Yes | 1154 | (83.7) | 0 | (0.0) |
Parent and family characteristics | ||||
Parental educational level | ||||
Low | 242 | (17.6) | 32 | (7.4) |
Medium | 694 | (50.4) | 207 | (47.9) |
High | 387 | (28.4) | 193 | (44.7) |
Family composition | ||||
Biological two-parent family | 652 | (47.3) | 328 | (74.0) |
Other | 723 | (52.6) | 115 | (26.0) |
Parenting problems | ||||
No | 949 | (71.5) | 373 | (86.3) |
Yes | 378 | (28.5) | 59 | (13.7) |
Family problems | ||||
No | 886 | (66.8) | 398 | (92.3) |
Yes | 440 | (33.2) | 33 | (7.7) |
Care-related characteristics | ||||
Type of psychosocial care | ||||
Preventive child healthcare | 366 | (26.6) | – | – |
Child and adolescent social care | 234 | (17.0) | – | – |
Child and adolescent mental healthcare | 778 | (56.5) | – | – |
Not in care | – | – | 443 | (100.0) |
Age and gender | Enrolled in care | Not enrolled in care | P1
| PCH | CASC | CAMH | P2
| |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N = 1378 |
N = 443 |
N = 366 |
N = 234 |
N = 778 | ||||||||
N
| (%) |
N
| (%) |
N
| (%) |
N
| (%) |
N
| (%) | |||
Age
| ||||||||||||
4–11 years (i.e. primary school age) | 828 | (60.1) | 268 | (60.5) | 316 | (86.3) | 100 | (42.7) | 412 | (53.0) | *** | |
12–19 years (i.e. secondary school age and further) | 550 | (39.9) | 175 | (39.5) | 50 | (13.7) | 134 | (57.3) | 366 | (47.0) | ||
Gender
| ||||||||||||
Male | 734 | (53.3) | 184 | (41.5) | *** | 185 | (50.5) | 102 | (43.6) | 447 | (57.5) | *** |
Female | 644 | (46.7) | 259 | (58.5) | 181 | (49.5) | 132 | (56.4) | 331 | (42.5) | ||
Problems T1
| ||||||||||||
Internalizing problems | 916 | (66.5) | 70 | (15.8) | *** | 202 | (55.2) | 148 | (63.2) | 566 | (72.8) | *** |
Externalizing problems | 739 | (53.6) | 39 | (8.8) | *** | 143 | (39.1) | 146 | (62.4) | 450 | (57.8) | *** |
Parenting problems | 378 | (28.5) | 59 | (13.7) | *** | 73 | (20.2) | 80 | (38.5) | 225 | (29.7) | *** |
Family problems | 440 | (33.2) | 33 | (7.7) | *** | 92 | (25.4) | 97 | (46.6) | 251 | (33.2) | *** |
Number of problems | ||||||||||||
No problems | 172 | (13.0) | 282 | (65.4) | *** | 93 | (25.8) | 19 | (9.2) | 60 | (7.9) | *** |
1 problem | 367 | (27.7) | 108 | (25.1) | 109 | (30.2) | 41 | (19.8) | 217 | (28.7) | ||
2 problems | 424 | (32.0) | 35 | (8.1) | 97 | (26.9) | 63 | (30.4) | 264 | (35.0) | ||
3 problems | 231 | (17.5) | 3 | (0.7) | 44 | (12.2) | 51 | (24.6) | 136 | (18.0) | ||
4 problems | 129 | (9.8) | 3 | (0.7) | 18 | (5.0) | 33 | (15.9) | 78 | (10.3) |
Types of problems upon enrolment
Outcomes
Type of problems (T1) per care type or not in care | Enrolment | Process-outcome | Outcomes after 3 months | Outcomes after 12 months | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Problemsa
| Problem severity | Care duration | Resolved problemsbc
| Problem severity changeb
| Resolved problemsbc
| Problem severity changeb
| |||||
0–3 months | > 3–12 months | > 12 months | |||||||||
N
|
M
| (SE) | % | % | % | Δ (%) | Δ (%) | Δ (%) | Δ (%) | ||
Internalizing problems | |||||||||||
PCH | 202 | 9.0 | (0.19)*** | 56.8 | 13.6 | 29.5*** | −38.1** | −20.5** | −54.0*** | −34.2*** | |
CASC | 148 | 8.9 | (0.21) | 32.5 | 23.0 | 44.4 | −26.4 | −10.6 | −39.2 | −15.8 | |
CAMH | 556 | 9.4 | (0.12) | 34.5 | 23.3 | 42.1 | −26.3 | −16.4 | −34.6 | −23.4 | |
Not in care | 70 | 6.8 | (0.24) | – | – | – | −40.0 | −13.3 | −54.3 | −22.3 | |
Externalizing problems | |||||||||||
PCH | 143 | 11.4 | (0.21) *** | 46.3 | 18.7 | 35.0#
| −33.6 | −12.7 | −48.3 | −21.7#
| |
CASC | 146 | 11.4 | (0.26) | 32.8 | 25.6 | 41.6 | −34.2 | −11.5 | −49.3 | −22.7 | |
CAMH | 450 | 11.3 | (0.12) | 36.4 | 18.6 | 45.1 | −30.2 | −11.7 | −42.9 | −17.8 | |
Not in care | 39 | 8.8 | (0.32) | – | – | – | −43.6 | −10.3 | −53.8 | −13.7 | |
Parenting problems | |||||||||||
PCH | 73 | 2.6 | (0.03) *** | 63.3 | 20.0 | 16.7* | −54.8#
| −11.6* | −61.7#
| −15.8** | |
CASC | 80 | 2.7 | (0.04) | 37.1 | 21.4 | 41.4 | −36.6 | −9.5 | −38.5 | −10.4 | |
CAMH | 225 | 2.6 | (0.02) | 36.0 | 23.4 | 40.7 | −38.3 | −7.0 | −44.5 | −9.5 | |
Not in care | 59 | 2.5 | (0.03) | – | – | – | −35.6 | −5.6 | −48.3 | −8.0 | |
Family problems | |||||||||||
PCH | 92 | 2.3 | (0.03)** | 50.7 | 20.5 | 28.8#
| −39.7#
| −7.9 | −44.6 | −12.5 | |
CASC | 97 | 2.5 | (0.04) | 41.9 | 17.4 | 40.7 | −35.6 | −9.4 | −40.5 | −11.0 | |
CAMH | 251 | 2.4 | (0.02) | 34.1 | 23.7 | 42.2 | −38.2 | −7.7 | −42.3 | −11.9 | |
Not in care | 33 | 2.2 | (0.04) | – | – | – | −60.6 | −16.9 | −53.1 | −19.3 | |
Any problem | |||||||||||
PCH | 268 | 1.9d
| (0.05)*** | 56.0 | 15.8 | 28.2*** | −20.0e*** | – | −31.1e*** | – | |
CASC | 188 | 2.4d
| (0.07) | 37.2 | 22.1 | 40.7 | −8.9e
| – | −16.7e
| – | |
CAMH | 695 | 2.1d
| (0.04) | 37.3 | 22.8 | 40.0 | −11.9e
| – | −17.9e
| – | |
Not in care | 149 | 1.3d
| (0.05) | – | – | – | −27.8e
| – | −42.7e
| – |