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

Abstract

Background: Care for children and adolescents with psychosocial problems is aimed at reducing problems. There may be a relationship between the intensity and duration of care provision and improvement of these outcomes, but evidence on this issue is lacking. We therefore examined the association between care trajectories based on duration and intensity of care for children, and the reduction in psychosocial problems after 3 years. Methods: We obtained a cohort of all children entering psychosocial care in one region (n = 1,378), the TAKECARE cohort, and followed it for 3 years, with five assessment rounds. Retention in the final round was 85.8%. Psychosocial problems were measured using the parent report of the Total Difficulty Score of the Strength and Difficulties Questionnaire (SDQ-TDS). We constructed trajectories for intensity of care using growth mixture modelling and assessed the association between duration and intensity of care trajectories and SDQ-TDS after 3 years. Results: After 3 months 60.6% of children and adolescents were receiving care, after 1 year 38.7% were receiving care and after 3 years 26.0%. Regarding intensity of care, three trajectories were found: one with minimal intensity during all 3 years, a second with initially medium intensity and strong reduction within 1 year, and a third with high intensity and a reduction after 1 year. Although the psychosocial problems of children and adolescents were reduced during the 3-year period, the rate of decline was relatively less marked for children and adolescents with longer care trajectories. Conclusion: Overall, children and adolescents with psychosocial problems who received care had improved outcomes at follow-up. However, increased provision of care does not automatically lead to reduction of problems, and although overall psychosocial problems are reduced, a substantial subgroup has longer lasting problems.The outcome concerned the difference between the SDQ Total Difficulty Score (TDS) of the child/adolescent at the start of the care trajectory (T1) and 3 years thereafter (T5), reported by the Up to one in five children worldwide experience psychosocial problems, i.e. behavioral, emotional and social problems.Evidence on the outcomes of psychosocial care obtained in naturalistic settings is scarce and inconclusive. We found that the psychosocial problems of children and adolescents who received care were reduced during the 3-year period, but relatively less so for children and adolescents with longer care trajectories.Our findings underscore the importance of examination of the outcomes of psychosocial care for the children and adolescents with the most severe and lasting problems.

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

“…Regarding the intensity trajectories, we found that the intensity of care for two out of the three trajectories was particularly high in the first period. These findings corroborate earlier findings showing that the number of services provided was high at the start of care and then decreased (Yampolskaya et al, 2017), and can be interpreted as proving that for a majority of clients, professionals start with rather intensive care. Our finding of a third, persistently low-intensity trajectory is new and calls for further research on its reasons.…”

“…Finally, the reduction in the psychosocial problem levels of children and adolescents with longer care trajectories was relatively smaller. Our finding that care was frequently provided for <3 months confirms that most interventions for children and adolescents with psychosocial problems focus on short-term treatment gains (Mulqueen, Bartley, & Bloch, 2015;Wehry, Beesdo-Baum, Hennelly, Connoly, & Strawn, 2015). Moreover, the SDQ scores of children and adolescents with a short duration of care further improve after care has ended after 3 months.…”

“…In addition, another study showed a significant relationship between the number of treatment sessions (more than 8) and improvement in psychiatric symptoms (measured with the Child and Adolescent Psychiatric Assessment) at follow-up (Angold, Costello, Burns, Erkanli, & Farmer, 2000). However, other studies reported different findings, including no association between treatment and improved outcomes at followup (J€ org et al, 2012;Zwaanswijk, Verhaak, Van Der Ende, Bensing, & Verhulst, 2006), a very limited association (Trask & Garland, 2012), improvement limited to some subgroups, namely children with low to moderate externalizing problems (Tabone, Thompson, & Wiley, 2010), and even worse mental health outcomes after increased provision of treatment (Yampolskaya, Sharrock, Clark, & Hanson, 2017). A reason for these heterogeneous findings may include a rather crude assessment of treatment, that is, only dichotomized as yes/no treatment (Tabone et al, 2010;Trask & Garland, 2012;Zwaanswijk et al, 2006).…”