Professional Identification of Psychosocial Problems among Children from Ethnic Minority Groups: Room for Improvement
ABSTRACT 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.
SourceAvailable from: S.A. Reijneveld[Show abstract] [Hide abstract]
ABSTRACT: Moderately preterm (MP) birth is associated with higher rates of behavioural and emotional problems. To determine the extent to which low socioeconomic status (SES) contributes to these higher rates, we assessed independent and joint effects of MP birth and low SES, overall and by gender. Dutch preventive child health care centres provided a population-based sample of 915 MP children (32-36 weeks gestation) and 543 term-born children, born in 2002/2003. In multivariable logistic regression analyses, we determined the risk of behavioural and emotional problems per standard deviation (SD) decrease in gestational age and SES, using standardized measures for both. We also assessed three SES categories, being low (1SD or more below mean of standardized SES), intermediate (mean ± 1SD), and high (greater than mean + 1SD). The Child Behavior Checklist for 1.5-5 years was used to assess behavioural (externalizing), emotional (internalizing), and total problems at age 4 years. MP children with low SES had significantly higher total problem scores than those with high SES (11.3 vs. 5.1 %, respectively). Each SD decrease in SES was associated with a 42 % higher odds of elevated total problem scores (OR 1.42, 95 % CI 1.14-1.77). No joint effects were found, meaning that lower gestational age independently added to the risk of behaviour problems (OR 1.24, 95 % CI 1.00-1.56). Effects of MP birth and low SES were more pronounced in girls. In conclusion, MP birth and low SES multiply the risk of behavioural and emotional problems. The combination of risk factors identifies children who could benefit greatly from early intervention.European Child & Adolescent Psychiatry 10/2014; DOI:10.1007/s00787-014-0623-y · 3.55 Impact Factor
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ABSTRACT: OBJECTIVE: To construct a risk score for adolescent mental health problems among children, using parental data only and without potentially stigmatizing mental health items. METHODS: We prospectively derived a prediction model for mental health problems at age 16 using data from parent report on 1676 children aged 11 from the general population. Mental health problems were considered present in the top 15% scores on the combined Achenbach ratings. The model was validated in a separate cohort (n = 336) children. A risk score was constructed for practical application. RESULTS: In the derivation cohort, 248 (14.8%) had mental health problems at follow-up. Predictors in the final model were gender, maternal educational level, family history of psychopathology, math achievement at school, frequently moving house, severe disease or death in the family, parental divorce, and child frustration level. The model was well calibrated, showed good discriminatory power (area under the curve 0.75; 95% confidence interval 0.72-0.78), and validated well. The risk score stratified children in classes of risk ranging from 6.6% to 52.2%. CONCLUSIONS: A risk score based on parent-reported data only and without mental health items accurately estimated the 5-year risk of adolescent mental health problems among children from the general population. Children with high risk may benefit from further monitoring or intervention. The risk score may be particularly suitable when parents want to circumvent an explicit discussion on possible mental health problems of their child.Academic pediatrics 11/2014; 14:589. DOI:10.1016/j.acap.2014.07.006. · 2.23 Impact Factor
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ABSTRACT: Psychosocial problems in children have adverse effects on the children, their families, and society, thus early intervention is important. Community pediatric services offer an ideal setting to detect problem behaviour in children and provide support to parents. The objective of this study was to assess the effectiveness of a Primary Care Triple P (PCTP) program compared with care as usual (UC) for parents of children with mild psychosocial problems after an initial, evidence-based screening in routine community pediatric care. We conducted a multicenter, randomized, controlled trial in community pediatric services in the Netherlands, enrolling parents of children with mild psychosocial problems. The population was identified by screening using the Strengths and Difficulties Questionnaire (SDQ) with a cut-off point of 11 or higher (that is, a subclinical score). We compared PCTP with UC, and measured the effects immediately after treatment and after 6 and 12 months. PCTP comprised four individual counseling sessions with the parent of 20 to 30 minutes each. The primary outcome measures were the child psychosocial problems as measured by the SDQ and the Eyberg Child Behaviour Inventory (ECBI). In total, 81 families were recruited and randomized, and 67 provided post-intervention data. Both treatment groups improved after treatment, with the PCTP group improving only slightly more than the UC group on most measures. The maximum difference on the SDQ was 1.94 (95% CI = -0.30 -- 4.19, P = 0.09) and 5.81 (95% CI = -3.37 -- 14.99, P = 0.21) on the ECBI (n = 67). None of the differences between PCTP and UC was significant. In the subsidiary analyses, only one (the SDQ conduct problems score) of the twenty scores was significant. PCTP did produce a reduction in psychosocial problems in children but had no statistically significant advantage over UC. In general, a few outcomes improved in both groups. Based on this admittedly underpowered study, we cannot conclude that PCTP is more effective than UC in preventive child healthcare.Trial registration: Nederlands Trial Register (Dutch Trial Register): NTR1338.BMC Medicine 11/2013; 11(1):240. DOI:10.1186/1741-7015-11-240 · 7.28 Impact Factor