Marieke Zwaanswijk

Help seeking for emotional and behavioural problems in children and adolescents: a review of recent literature.

Abstract.In order to understand the discrepancy between rates of child and adolescent psychopathology and rates of mental health service use, variables influencing the help-seeking process need to be investigated. The present article aims to extend and refine previous findings by reviewing 47 recent empirical studies on parental and adolescent problem recognition and help seeking, and problem recognition by the general practitioner (GP). Several variables (child age, the presence of medical and school-related problems, informal help seeking, past treatment of parents or relatives, family size, and type of maltreatment) were discovered to influence parental/adolescent problem recognition and/or help seeking,while refinements were found for the effects of type of psychopathology, child gender, adolescent attitudes and personality, parental psychopathology, social support, and sociodemographic variables. Although recent studies uncovered several determinants of problem recognition by the GP (child gender, age, past treatment, academic problems, family composition, life events, type of visit, and acquaintance with child), this aspect of the help-seeking pathway remains relatively uncharted and, therefore, needs to be the focus of future research.

Factors associated with adolescent mental health service need and utilization.

OBJECTIVE To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. METHOD Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of 1,120 Dutch adolescents aged 11 to 18 years (78% response rate). RESULTS 3.1% of the sample had been referred for mental health services within the preceding year, and 3.8% reported unmet need. 7.7% of adolescents at risk for psychopathology, and 17.8% of those indicating a need for help, had been referred. Family stress and adolescents self-reported problems were most strongly associated with service need and utilization. Internalizing problems, female gender, and low education level were associated with self-perceived unmet need. Adolescent ethnicity and competence in activities and school were associated with service use, but did not influence service need, while the opposite effect was found for adolescent age and parental psychopathology. CONCLUSION In designing intervention programs aimed at increasing adolescent mental health service use, distinctions should be made between efforts focused at adolescents not recognizing their problems, and those with unmet need.

Online focus groups as a tool to collect data in hard-to-include populations: examples from paediatric oncology

BackgroundThe purpose of this article is to describe and evaluate the methodology of online focus group discussions within the setting of paediatric oncology.MethodsQualitative study consisting of separate moderated asynchronous online discussion groups with 7 paediatric cancer patients (aged 8–17), 11 parents, and 18 survivors of childhood cancer (aged 8–17 at diagnosis).ResultsAll three participant groups could be actively engaged over a one-week period. Respondents highly valued the flexibility and convenience of logging in at their own time and place to join the discussion. Adolescent patients and survivors emphasized that the anonymity experienced made them feel comfortable to express their views in detail. The findings indicate a strong preference for online group discussions across all participant groups.ConclusionThe findings show that online focus group methodology is a feasible tool for collecting qualitative data within the setting of paediatric oncology, and may offer new opportunities to collect data in other hard-to-include populations. The evaluations seem to indicate that the online group discussions have given participants an opportunity to articulate their experiences and views in a way they might not have done in a traditional group discussion.

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences

Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences.

The different stages and actors involved in the process leading to the use of adolescent mental health services.

Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12—17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teachers role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral.

Advantages of asynchronous online focus groups and face-to-face focus groups as perceived by child, adolescent and adult participants: a survey study

BackgroundOnline focus groups (OFGs) are increasingly used as a method of data collection. Although their advantages for research have repeatedly been described, participants’ opinions about OFGs have seldom been studied. We investigated OFG participants’ preference for participation in an OFG or a face-to-face focus group (FTF), as well as their perceptions of the advantages of both methods. We also investigated whether any differences exist between the perceptions of child, adolescent, and adult participants.MethodsParticipants’ opinions were studied by means of a questionnaire completed by 284 persons (aged 8–72 years) after their participation in one of 50 OFGs. The OFGs were conducted between December 2005 and December 2013 as part of 19 separate studies. Chi square tests with p <0.05 were used to test differences in perceived advantages of OFGs and FTFs between children, adolescents and adults.ResultsThe most important advantage of OFGs as perceived by OFG participants was the possibility to participate at a moment most convenient to them. Adolescents and adults (90.5% and 95.9%) more often reported this as an advantage than children did (30.8%, p < 0.02). Another important perceived advantage of OFGs was the possibility to participate from home (69.1%). The most important advantage of FTFs was respondents’ perception that it is easier to have a discussion with the whole group when there is personal contact with others (48.5%). This advantage was mentioned significantly more often by adults (78.4%) than by children and adolescents (4.8% and 17.7%, p < 0.02).ConclusionsParticipants’ perceptions of OFGs partly concur with the advantages of OFGs as a research method. Whereas respondents generally value the convenience of participating at their own time and place, the anonymity of OFGs and the increased ease to discuss personal issues were mentioned less often as advantages by the participants. An aspect that may need more attention when conducting an OFG, is the absence of a fluid discussion, which is, according to our respondents, easier to achieve in an FTF. This underlines the importance of the moderator in enabling a constructive discussion.

A new approach to child mental healthcare within general practice

BackgroundChild and adolescent mental health problems are frequently not identified and properly treated within general practice. Politicians in the Netherlands are promoting more primary healthcare treatment for mental health problems. The current study aims to evaluate an integrated primary mental healthcare approach for child and adolescent emotional and behavioural problems. This integrated approach allows general practitioners (GPs) to comprehensively explore the request for help, followed by an informed decision to refer, offer short-term treatment within general practice or postpone a decision by asking for additional consultations with youth mental health specialists.MethodThe study is a naturalistic evaluation of Dutch general practices with pre-test and post-test comparison with controls based on data from Electronic Medical Records (EMR). The intervention started in September 2010. EMR data of all GP contacts with children aged 4 to 18 (including diagnosis, prescriptions, referrals) from practices involved in the intervention was used from 1 January 2009 to 31 December 2012. Extra codes were added to the EMR to record aspects of the intervention. Comparable EMR data was used in control practices in 2011.ResultsGPs in the intervention group were able to identify more emotional and behavioural problems after the integrated service had started. They also identified more problems than GPs in the control practices. They were already reluctant to prescribe psychopharmacological medication to children before the intervention, and levels of prescription at intervention GP practices remained low for psychotropic drugs compared to control practices. Referral rates to mental healthcare remained relatively steady after the introduction of the integrated service, but referrals switched from specialized to primary mental healthcare.ConclusionAn integrated mental healthcare approach within general practice may lead to an increase in detected psychosocial problems among children, and these problems can mainly be treated within the primary care setting.