Professional Identification of Psychosocial Problems among Children from Ethnic Minority Groups: Room for Improvement

Leiden University Medical Center, Department of Public Health and Primary Care, PO Box 9600, 2300 RC Leiden, The Netherlands.
The Journal of pediatrics (Impact Factor: 3.79). 11/2009; 156(2):277-84.e1. DOI: 10.1016/j.jpeds.2009.08.008
Source: PubMed


To assess the effectiveness of child health care professionals (CHP) in identifying psychosocial problems among children originating from industrialized and nonindustrialized countries and to assess whether parental concerns enhance CHP problem-identification.
During routine well-child visits data were collected from a sample of children aged 5 to 12 years of Dutch, Moroccan, Turkish, Surinam, and Antillean origin (response: 82%). CHP reported on psychosocial problems that they identified in children. Parents completed the Child Behavior Checklist (CBCL) and a questionnaire on concerns regarding their child's psychosocial development. Interpreter services were used to support parents in filling out questionnaires.
Elevated CBCL total and internalizing problem scores were more prevalent among children from nonindustrialized countries (10% and 17%, respectively) than among children from industrialized countries (3% and 5%, respectively). About 30% of the Turkish and Moroccan children with an elevated CBCL score were identified by CHPs compared with 60% of the children from industrialized countries. Parental concerns on their child's psychosocial well-being were related to elevated CBCL scores. Concerns were not related to CHP problem-identification.
Better methods to support parents in disclosure of their concerns regarding the psychosocial development of their children may enhance CHP-identification of problems, especially among groups from nonindustrialized countries.

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Available from: S.A. Reijneveld, Oct 04, 2015
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    • "We obtained a national sample using a two-stage selection procedure. In the first stage, a random sample of services addressing school-aged children was drawn using random numbers (15 out of a total of 40 services) [20,21]. The sample was stratified by region and degree of urbanization of the districts. "
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    ABSTRACT: Youth antisocial behaviour is highly prevalent. Young people are usually not willing to disclose such behaviour to professionals and parents. Our aim was to assess whether child health professionals (CHP) working in preventive child healthcare could identify pre-adolescents at risk for antisocial behaviour through using data that they obtain in routine practice. CHPs examined a national sample of 974 pre-adolescents aged 8-12 years (response 79.1%), and interviewed parents and children during routine well-child assessments. We obtained data on family background and current health of the child from the CHP; on developmental concerns from parents, and on social and emotional well-being, injuries, and substance use from the children. Antisocial behaviour concerned the adolescent-reported 15 item International Self-Reported Delinquency study questionnaire, among which are 5 items on violence against people. The prevalence of 2+acts of any antisocial behaviour was 21.8%, and 33.9% for 1+acts of violence (10.5% for 2+). Children who were male, had a young mother, no parent employed, recent injuries, poor performance at school or who were bored by school, and who had parental concerns more often reported 2+antisocial acts and 1+violence against people. Detection algorithms on the basis of these variables were moderately able to classify outcomes, with Areas-Under-the-Curves ranging from 0.66 to 0.71. Data from routine well-child assessment can help CHPs to detect pre-adolescents at risk for antisocial behaviour, but detection algorithms need to be further improved. This could be done by obtaining additional information on factors that are associated with antisocial behaviour.
    BMC Pediatrics 03/2012; 12(1):24. DOI:10.1186/1471-2431-12-24 · 1.93 Impact Factor
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    • "In the Netherlands, Preventive Child Healthcare (PCH) offers an ideal opportunity for the early detection of psychosocial problems among preschool children, comparable to community pediatrics in the USA. In this system, child health professionals (further: CHP), i.e. doctors and nurses, working in preventive child healthcare offer routine well-child care clinics, including the early detection and treatment of psychosocial problems to the entire Dutch population [12,13]. Access is free of charge. "
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    ABSTRACT: Considering the high burden of disease of psychosocial problems in children and adolescents, early intervention regarding problem behaviour of young children is very important. The Preventive Child Healthcare (PCH) offers a good setting to detect such problem behaviour and to provide parenting support to the parents concerned. This paper aims to describe the design of an effectiveness study of a parenting programme for parents of children with mild psychosocial problems after an initial, evidence based screening in routine PCH. The effects of the intervention will be studied in a randomised controlled trial. Prior to a routine PCH health examination, parents complete a screening questionnaire on psychosocial problems. Parents of children with increased but still subclinical levels of psychosocial problems will be assigned at random to the experimental group (Triple P, level 3) or to the control group (care as usual). Outcome measures, such as problem behaviour in the child and parenting behaviour, will be assessed before, directly after and 6 and 12 months after the intervention. Parenting support may be an effective intervention to reduce psychosocial problems in children but evidence-based parenting programmes that fit the needs of the PCH are not available as yet. Although the Triple P programme seems promising and suitable for a universal population approach, evidence on its effectiveness in routine PCH still lacks. NTR1338.
    BMC Public Health 03/2010; 10(1):131. DOI:10.1186/1471-2458-10-131 · 2.26 Impact Factor
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    ABSTRACT: Objective of this study was to assess the degree to which preventive child health professionals (CHPs) identify and act upon psychosocial problems among young toddlers in the general population and to determine the concordance with parent-reported behavioural and emotional problems. Also, associations of psychosocial problems with socio-demographic factors, and (mental) health history of the toddlers were studied. CHPs examined a national sample of children aged 14 months and interviewed their parents during the routine health assessments. Identification of and action upon psychosocial problems by CHPs were registered. The Infant-Toddler Social and Emotional Assessment (ITSEA) was completed by the parents. Data were available on 701 Dutch 14-month-old toddlers. In 7.6% of all toddlers, CHPs identified one or more psychosocial problems. Forty-seven percent of identified children were referred to another professional or received follow-up. Identification of psychosocial problems and subsequent action were 3-16 times more likely in children with clinical parent-reported problem behaviour according to the Dutch adapted version of the ITSEA. Also, past or current professional care for psychosocial problems was associated with the CHPs' identification or action. Associations with socio-demographic variables were weak. The CHPs frequently identify psychosocial problems in 14-month-old toddlers, but they miss many cases of parent-reported problems as measured by a clinical ITSEA score. This general population study shows substantial room for improvement in the early identification of psychosocial problems in young toddlers.
    The European Journal of Public Health 10/2009; 20(3):332-8. DOI:10.1093/eurpub/ckp169 · 2.59 Impact Factor
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