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With this project, we aim to facilitate the inclusiveness of mental health care in the Netherlands particularly for vulnerable (ethnic minority) youth. With inclusive, we mean that DSAV and professional mental health care is accessible and that it improves the mental health and the sense of empowerment of vulnerable children and their parents. We do so by identifying which elements of the early intervention approach ‘DSAV’ contribute to the prevention and reduction of mental health problems and costs of which vulnerable (in particular ethnic minority) boys and girls and to their and their parents’ empowerment?

De School Als Vindplaats’ (DSAV) is a school-based early detection and intervention program financed by the municipality of Nijmegen. On all elementary schools in Nijmegen, DSAV experts from the GGZ organizations in Nijmegen support teachers in detecting youth with social-emotional or behavioural problems and provide short (maximum of 8 sessions), personalized, systemic, culture-sensitive, solution-oriented and where possible evidence-based interventions that aim to reduce mental health problems and empower the families. So far, DSAV has been particularly successful in reaching ethnic minority youth, youth with a low Social Economic Status, multi-problem families and boys.

Studies have shown that while the prevalence rates of mental health problems are higher among many ethnic minority youth in Europe compared to ethnic majority youth, they are in fact underrepresented in the mainstream mental health care, and over-represented in the heavier, forced and more expensive mental health care system, which results in higher costs. Many of them do not seek or find professional (GGZ) help in time, or drop out of the treatment process. To complicate matters, ethnic background is confounded with having a low Social Economic Status and intersects with sex (biological attributes) and gender (socially constructed roles and behaviors). SES and sex/gender also contribute to determining the risks of exposure to mental health stressors, the development of disorders, the expression of the symptoms of those disorders and particularly relevant for this study, whether mental health problems are recognized e.g. by teachers or professionals in mental health care.

These interconnected variables influence the accessibility and treatment effects of mental health care in various ways, and so making mental health care more inclusive should also address various elements. Elements include: being proactive without (gender and cultural)stereotyping, lowering the threshold for access (no administrative, financial, logistical or other barriers) and reducing the stigmatizing effects of mental health care. Moreover, elements improving the effects of the preventive mental health care interventions for vulnerable groups include: empowerment of families (including improving their view on mental health care professionals), personalizing the care by matching the problem definition with that of the families and cultural competence of the professionals including their expertise in intercultural communication. DSAV is an attempt to include all these elements, and so studying how effective it is, is a way of finding out the importance of including these elements to ‘care as usual’.

 

Using qualitative and quantitative data we examine how successful the intervention is in identifying youth with mental health problems and which effects DSAV has on the reduction of mental health problems and on the empowerment of parents to deal with social-emotional problems of their child (study I). Moreover, we will study which elements of DSAV are most effective and inclusive according to the children, parents and professionals compared to ‘care as usual’ (study II). Finally, we will study the cost-effectiveness of DSAV to offer evidence and tools for calculating the cost-effectiveness of prevention programs in the long run (study III).

 

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