Enrolment of children and adolescents in psychosocial care: more likely with low family social support and poor parenting skills

Abstract

Knowledge about determinants of child and adolescent enrolment in psychosocial care concerns only single types of care and usually only socio-demographic factors. The social environment is also a likely key determinant but evidence is lacking. The aim of this study was to examine the associations between family social support, parenting skills and child and adolescent enrolment in psychosocial care. We obtained data on 1,331 children (response rate 56.6 %), 4-18 years old, enrolled in preventive child health care, and child and adolescent social care and mental health care because of psychosocial problems, and on 463 children (response rate 70.3 %) not enrolled in psychosocial care. Results showed that enrolment in psychosocial care was associated with low family social support (odds ratio; 95 %-confidence interval: 3.2; 2.4-4.4), and with poor parenting skills, i.e. poor supervision (1.5; 1.1-2.1) and inconsistent disciplining (1.5; 1.1-2.1). Children's psychosocial problems partially mediated the associations with family social support and completely with parenting skills. Children's problems did not moderate the associations. Positive parenting was not associated with care enrolment. We conclude that low family social support and poor parenting are important factors associated with enrolment, in particular because they are associated with more frequent occurrence of children's psychosocial problems. This implies that professionals and policymakers need to be aware that factors in children's social environment are related with enrolment in psychosocial care, in addition to children's psychosocial problems.

Adolescent Enrollment in Psychosocial Care: Do Parents Make a Difference?

“…Parents of adolescents who reported EBP and were enrolled in psychosocial care (Group 4) had a significantly lower socioeconomic position and poorer supervision than those without EBP and not in care (Group 1). Our findings are in line with previous studies showing low socioeconomic position and poor supervision to be associated with psychosocial problems in adolescents and a higher likelihood of enrollment in psychosocial care [ 17 , 18 , 19 , 21 , 30 ]. An explanation for these findings may regard the family stress model, which explains how economic disadvantage leads to worse parenting and psychological distress of parents, and this subsequently leads to worse developmental outcomes in adolescents [ 31 ].…”

“…An explanation for these findings may regard the family stress model, which explains how economic disadvantage leads to worse parenting and psychological distress of parents, and this subsequently leads to worse developmental outcomes in adolescents [ 31 ]. Poorly supervised adolescents, probably due to less correction of their antisocial behavior, connect more with antisocial peers, have more psychosocial problems and enroll in psychosocial care more frequently [ 21 , 32 ]. Still, due to the cross-sectional design of our study, causality could not be clearly stated.…”

“…Parents perceive that their adolescents with EBP need care more frequently when they themselves report having psychological problems, having used care for these problems before [ 16 , 20 ] or experiencing stress [ 14 ]. The enrollment of adolescents into psychosocial care is also associated with poor parenting skills [ 21 ] and low family social support [ 21 , 22 ].…”

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

“…Potential confounders regarded age (Reijneveld, Brugman, Verhulst, & Verloove‐Vanhorick, ; Simpson, Cohen, Bloom, & Blumberg, ), gender (Bussing, Zima, Gary, & Garvan, ; Cuffe, Moore, & McKeown, ), family composition (Costello, He, Sampson, Kessler, & Merikangas, ), educational level (Reijneveld et al., ), social support (Nanninga, Jansen, Knorth, & Reijneveld, ), parenting skills (Nanninga et al., ), and problem severity measured with the SDQ‐TDS (Bussing et al., ; Klein Velderman, Crone, Wiefferink, & Reijneveld, ), all measured during the first measurement round (T1: entry into care). These potential confounders were chosen based on the indicated prior empirical research.…”

“…Parenting skills were measured by two subscales of the nine‐item version of the Alabama Parenting Questionnaire (APQ) (Elgar, Waschbusch, Dadds, & Sigvaldason, ). Research shows that of the three original subscales, inconsistent discipline and poor supervision are associated with care enrolment and that there is no association with positive parenting (Nanninga et al., ). The subscales were measured on a five‐point Likert scale.…”