Trajectories of care for children and adolescents with psychosocial problems: a 3‐year prospective cohort study

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Video abstract from Vera Verhage JCPP paper ‘Trajectories of care for children and adolescents with psychosocial problems: a 3‐year prospective cohort study’

Authors: Vera Verhage, Danielle E.M.C. Jansen, Josue Almansa, Charlotte Wunderink, Hans Grietens, Sijmen A. Reijneveld

First published: 20 October 2019 doi.org/10.1111/jcpp.13137

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Vera Verhage
Vera Verhage

Vera Verhage is a PhD Candidate at the University Medical Center Groningen (UMCG), University of Groningen. Vera does research in Public Health, Epidemiology and Emergency Medical Care.

Transcript

Hello.  My name is Vera Verhage and I am a PhD student based in the University Medical Centre in Groningen and I work as a teacher in social work at the University of Applied Sciences also in Groningen, the Netherlands.

This video abstract is intended to give a very brief overview of a paper my colleagues and me recently published in the Journal of Child Psychology and Psychiatry.  In this paper, we examined association between characteristics of children and adolescents, based on duration and intensity of care and the reduction in psycho social problems after three years.  From previous research, we know that up to one in five children worldwide experience psycho social problems.  That is behavioural, emotional or social problems.  It’s important that these children and adolescents receive timely and effective treatment, because this problem affects daily and social functioning.  In addition, early treatment of psycho social problems in childhood benefits health and development in later life.  Trials of effectiveness of psycho social intervention have shown that some treatments for specific problems have positive effects.  The settings of such trials however differ from the routine care provision in more naturalistic settings where comorbidities are more common and treatments are typically less intensive.

Therefore, we investigated long-term outcomes of psycho social care for children and adolescents in a naturalistic setting.  We described duration and intensity in trajectories and looked at problem reduction after three years.  We used a perspective cohort study named Take Care, which is set up in the Netherlands.  We followed children and adolescents after entering care for their psycho social problems during a three-year period with five measurement rounds.  Various types of care were included.  Preventive child healthcare, child and adolescent social care and child and adolescent mental healthcare.  Problem reduction was measured with a parent report of the strength and difficulty questionnaire.  Intensity of care regarded amount of care in number of hours and duration of care regarded time period in months between the first day of care and the last day of care during the three-year period.

So, what did we find?  We found the children and adolescents with psycho social problems who received care had improved outcomes at follow-up.  The psycho social problems of children and adolescents were reduced during the three-year period, but the rate of decline was relatively less for children and adolescents with longer care duration.  We also found that the higher care intensity does not automatically lead to a reduction of problems.  The overall trend of problem reduction is positive.  It might be interpreted as an indicator of the quality of care.  However, about a quarter of children and adolescents still receive care after three years and, as the of children and adolescents with longer care trajectories improved less in comparison with children and adolescents with shorter care duration.  A total reduction of problems may therefore simply not be achievable for a substantial group of children and adolescents.  Psych social care may not always reduce problems and may even then improve the functioning of adolescents.  We will therefore focus on outcome, self-reporting functioning in our next paper.  We will look at outcomes for adolescents with internalising or externalising problems or both and investigate if these large diagnostic groups differ in self-reported functioning over time, and the role of care in those trajectories.

But this is work in progress, so for now, thank you so much for watching.

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