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Identification and Management of Psychosocial Problems by Preventive Child Health Care
Emily Brugman, MSc;
Sijmen A. Reijneveld, MD, PhD;
Frank C. Verhulst, MD, PhD;
S. Pauline Verloove-Vanhorick, MD, PhD
Arch Pediatr Adolesc Med. 2001;155:462-469.
Objectives To assess the degree to which physicians and nurses working in preventive
child health care (child health professionals [CHPs]) identify and manage
psychosocial problems in children, and to determine its association with parent-reported
behavioral and emotional problems, sociodemographic factors, and general and
mental health history of children.
Design The CHPs examined the child and interviewed parents and child during
their routine health assessments. The parents completed the Child Behavior
Checklist.
Setting Nineteen child health care services across the Netherlands, serving
nearly all school-aged children routinely.
Subjects Of 4970 children aged 5 through 15 years, eligible for a routine health
assessment, 4480 (90.1%) participated.
Main Outcome Measures Identification and management of psychosocial problems by CHPs.
Results In 25% of all children, CHPs identified 1 or more psychosocial problems.
One in 5 identified children were referred for further diagnosis and treatment.
Identification of psychosocial problems and subsequent referral were 6 times
more likely in children with serious parent-reported problem behavior according
to the Child Behavior Checklist total problem score (8% of total sample).
However, CHPs identified no psychosocial problems in 43% of these children
and therefore undertook no action. Other child factors associated with CHPs'
identification and referral were past treatment for psychosocial problems,
life events, and academic problems. After adjustment for these, sociodemographic
characteristics did not predict referral.
Conclusions The CHPs identify psychosocial problems in school-aged children frequently
and undertake actions for most of them. Screening for psychosocial problems
may be a promising option to reduce these problems, but accurate identification
should be enhanced.
From TNO Prevention and Health, Leiden, the Netherlands (Ms Brugman
and Drs Reijneveld and Verloove-Vanhorick); and the Department of Child and
Adolescent Psychiatry, Erasmus University Rotterdam, Academic Hospital Rotterdam-Sophia,
Rotterdam, the Netherlands (Dr Verhulst).
Corresponding author and reprints: S. A. Reijneveld, MD, PhD, TNO
Prevention and Health, PO Box 2215, 2301 CE Leiden, the Netherlands (e-mail: SA.Reijneveld{at}pg.tno.nl).
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