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August 2004

Identification and Management of Psychosocial Problems Among Toddlers in Dutch Preventive Child Health Care

Author Affiliations

From TNO (Netherlands Organisation of Applied Scientific Research) Prevention and Health, Leiden (Drs Reijneveld and Verloove-Vanhorick and Ms Brugman), Department of Health Sciences, Groningen University, Groningen (Dr Reijneveld), Erasmus University Rotterdam, Academic Hospital Rotterdam-Sophia, Rotterdam (Dr Verhulst), and Department of Paediatrics, Leiden University Medical Centre, Leiden (Dr Verloove-Vanhorick), the Netherlands.

Arch Pediatr Adolesc Med. 2004;158(8):811-817. doi:10.1001/archpedi.158.8.811

Objectives  To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among preschool children in the general population and to determine the association with parent-reported behavioral and emotional problems, sociodemographic factors, and mental health history of children.

Design  The CHPs examined the child and interviewed the parents and child during their routine health assessments. The Child Behavior Checklist (CBCL) was completed by the parents.

Setting  Sixteen child health care services across the Netherlands that routinely provided well-child care to nearly all preschool children.

Patients  Of 2354 children aged 21 months to 4 years who were eligible for a routine health assessment, 2229 (94.7%) participated.

Main Outcome Measures  Identification and management of psychosocial problems by CHPs.

Results  In 9.4% of all children, CHPs identified psychosocial problems. Two in 5 of the CHP-identified children were referred for additional diagnosis and treatment. Identification of psychosocial problems and subsequent referral were much more likely in children with a clinical CBCL total problems score than in others (identification: 29% vs 7%; odds ratio [95% confidence interval], 5.40 [3.45-8.47]; referral: 15% vs 3%; odds ratio [95% confidence interval], 6.50 [3.69-11.46]).

Conclusions  The CHPs frequently identify psychosocial problems in preschool children, although less than among school-aged children, but they miss many cases of parent-reported problems as measured by a clinical CBCL score. This general population study shows substantial room for improvement in the early identification of psychosocial problems.