ARTICLES
Help-Seeking for Child Psychopathology: Pathways to Informal and Professional Services in The Netherlands

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ABSTRACT

Objective

To devise and test a model describing the process of help-seeking for child psychopathology in professional and informal service settings.

Method

Using structural equation modeling, associations between several help-seeking stages, and the influence of child, family, and context characteristics on these stages were investigated in 246 Dutch children (4-11 years old) between April 2000 and July 2002. Children were selected for having emotional or behavioral problems from a representative general practice sample; 68% of the selected children participated.

Results

School personnel played an important role in the process of help-seeking for child psychopathology, in both detecting service need and the provision of and the referral for help. Although Dutch general practitioners are supposed to be gatekeepers of mental health care, their role in help-seeking for child psychopathology was limited. Various family characteristics were shown to influence service need and informal or professional help-seeking. The influence of child characteristics on the help-seeking process was limited.

Conclusions

Educating parents about child psychopathology and the availability and accessibility of care, improving general practitioners' skills in detecting child psychopathology, and direct contact of mental health professionals with general practitioners and schools may enhance access to care for children in need.

Section snippets

Participants

Our study involved a two-stage procedure. An overview of the study design and the numbers of respondents for the various stages of the study is presented in Figure 2. The base population for the study was derived from the Second Dutch National Survey of General Practice, which examined morbidity and treatment in a representative sample of 104 general practices with 195 GPs and 385,461 listed patients between April 2000 and January 2002. A random sample of the practice population was asked to

RESULTS

To gain insight into the severity of child problems in our sample, numbers of children with CBCL and TRF Internalizing and Externalizing scores in the deviant range are reported in Table 2. Note that continuous rather than dichotomous scores on these scales were used in the structural equation model. Rates of service need and service use are also reported in Table 2.

Figure 3 depicts, in a simplified version of Figure 1, the percentages of parents at various stages of the help-seeking process,

DISCUSSION

This study was aimed at investigating in one comprehensive model the process of help-seeking for child psychopathology in both professional and informal service settings. By means of structural equation modeling, characteristics of the child, family, and context were investigated as determinants of various stages in the help-seeking process.

In general, structural equation modeling proved to be a fruitful method for concurrently testing associations between various stages in the help-seeking

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    Supported by grant2100.0064 from the Netherlands Organization for Health Research and Development.

    Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.

    Disclosure: The authors have no financial relationships to disclose.

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