Identification and management of psychosocial problems by preventive childhealth care

Objectives: To assess the degree to which physicians and nurses working in preventive child health care (child health professionals [CHPs]) identify a nd manage psychosocial problems in children, and to determine its associati on with parent-reported behavioral and emotional problems, sociodemographic factors, and general and mental health history of children. Design: The CHPs examined the child and interview ed parents and child duri ng their routine health assessments. The parents completed the Child Behavi or Checklist. Setting: Nineteen child health care services across the Netherlands, servin g 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 proble ms by CHPs. Results: In 25% of all children, CHPs identified 1 or more psychosocial pro blems. 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 (89; 1 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 p sychosocial 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 childre n frequently and undertake actions for most of them. Screening for psychoso cial problems may be a promising option to reduce these problems, but accur ate identification should be enhanced.