Onderkenning van en beleid bij psychosociale problemen in de schoolgezondheidszorg [Identification and management of psychosocial problems in school health care]

Objective. To assess the degree to which school 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 parentreported behavioural and emotional problems, sociodemographic factors, and medical history of children. Design. Descriptive. Method. 78 CHPs from 19 local health care services across the Netherlands examined 4,480 children aged 5 to 15 years (90% of the invited children), and interviewed parents and child during their routine health assessments from October 1997 to May 1998. The parents completed the Child Behavior Checklist (CBCL), as a measure of emotional and behavioural problems. CHPs did not know the CBCL-scores. Results. In 25% of all children, CHPs identified one or more psychosocial problems. They referred one in five identified children for further diagnosis and treatment; in 16% of cases they did not undertake any action. CHPs identified psychosocial problems in 57% of the children with serious parent-reported problems according to the CBCL (8% of total sample). In the children with problems according to the CBCL, identification and subsequent referral were six times more likely. Other child-related factors associated with CHPs' identification and referral were past treatment for psychosocial problems, life events, and academic problems. After adjustment for these factors, sociodemographic characteristics did not predict referral. Conclusion. CHPs identified psychosocial problems in school-aged children frequently and undertook actions for most of them. Screening for psychosocial problems may be a promising option to reduce these problems. However, accuracy of identification should be enhanced.