A major problem in youth care is the long waiting times. But thanks to the efforts of ‘youth practice assistants’ at general practitioners, fewer and fewer children are ending up on the waiting list. They are now active everywhere in the North.
Titia Neef, junior practice assistant at the Noorderbrood general practice in Nieuw-Buinen, recently received a gloomy girl at her consultation hour. After an extensive conversation about school, friends and how things are going at home, the girl talks about an argument at home. It had taken on a life of its own in her mind and weighed heavily on her mind. After three conversations with Neef, she already feels a lot better. Had she gone to the GP, the girl would probably have been referred to specialist care.
Where a GP has 10 minutes for a conversation, a POH (GP practice assistant) offers 20 minutes or 45 minutes and you can come back more often. A ‘POH Youth’ also often knows better to which agencies children and young people can be referred if the conversations do not help enough.
It is not without reason that GP Marinka van Dijk van Noorderbrood is happy with her practice assistant. “I spend much less time looking for referrals and children and young people now receive the right help quickly. And if they end up on a waiting list, then that is at least the right waiting list,” she concludes.
These waiting lists in youth care have been a problem for some time. According to a 2021 study by the Forgotten Child Foundation, children wait an average of more than 10 months for help. The Healthcare and Youth Inspectorate (IGJ) concluded in the same year that the number of children and young people needing psychological help is growing and that their problems are becoming more serious. Healthcare institutions do not have enough money and staff to meet all requests for help.
Only the lightest and heaviest care
In 2018, Van Dijk was the first general practitioner in Borger-Odoorn to appoint a POH Youth in her practice in Nieuw-Buinen. GPs themselves have a poor idea of which agencies there are and what they offer, she says.
She notices a ‘gap’ between specialist mental health care, the care and welfare offering of the municipality and the offering of the general practitioner himself. Children and young people who need short-term help do not actually fit anywhere. “We have been trained in the system of referral to mental health care. But it turns out that there are milder variants of concern that we are not aware of.”
Titia Neef is aware of these other options. She is one of four practice assistants in the municipality of Borger-Odoorn who focus on youth. “You just have to know about training from a welfare organization,” she says.
There is no special training for POH Youth (yet): Cousin studied social work and pedagogy and now regularly attends further training. “In the beginning it took a lot of getting used to. There were also weeks when I was in the practice, but had no patients,” she says. “But things are going well now.”
Differences between municipalities
With the growth in the number of youth practice assistants, it is increasingly important to know how to best fill this new position. Youth care organizations Accare, Molendrift and Karakter and the Knowledge Center for Child and Adolescent Psychiatry joined forces and conducted research between 2017 and 2019 at more than 250 general practices and among more than 2,500 patients in Friesland, Groningen and Gelderland.
According to the results, youth care at the GP can help an average of 41 percent of young people sufficiently so that a referral does not occur. Additional research data from more than 400 general practices and more than 8,000 patients shows that an average of four conversations is sufficient in 60 to 70 percent of cases.
Maarten Wetterauw, director of the Groningen youth care organization Molendrift, does notice differences per municipality. “Some municipalities have filled the position as ‘someone who knows the social map well, who has a little more time than a general practitioner and then makes a referral’. Then you may have a better referral, but still no immediate solution,” he says. “Or the youth is placed in the regular POH-mental health care for adults, a completely different area of knowledge.”
Wetterauw would like to see the job requirements adjusted to the knowledge acquired: “Frontrunners in effectiveness also appear to be the frontrunners in cost savings. These are behavioral scientists, psychologists or educational psychologists, with a number of years of work experience in specialist youth care.”
“Experienced, highly educated people can quickly distinguish between what is normal development and what is abnormal. Things that you can easily solve, you should solve easily. In this way we free up capacity to reduce waiting times for complex problems.”
Start right away
According to Wetterauw, the success of youth practice assistants has several possible explanations. “It is also about expectations: people are used to only having 10 minutes at the doctor’s office and are happy with every hour they get,” he says. “There is no waiting time at the GP: when it is finally your turn at the specialist youth care, people already have many more questions and they feel that they have to tell everything because everything really has to be arranged properly, otherwise they are back on the waiting list for months.”
The specialist youth care first conducts research, writes a report, draws up a treatment plan and then starts treatment. This is not necessary at the doctor’s office. “Many questions are still quite fresh. Then that approach is not necessary. If you can start immediately, the problem often turns out to be quite small.”
Additional advantage: the quick intervention is cheaper. While four consultations in a general practice will cost you 400 euros, those amounts in youth care usually only start at 2,500 euros. “And before you know it, you have a term of more than six months, after you had already been on the waiting list for four months.”
Three to eight conversations
Titia Neef conducts an average of three to eight conversations per young person. Her afternoon is usually fully planned: she sees four to five children. All kinds of things come up during her consultation hours: young people with suicidal thoughts and depression, parenting questions from parents with young teenagers, children who suffer from the divorce of their parents or parents who suspect autism or ADD in their child.
She estimates that she refers about half. “A few conversations with the child are often sufficient. And sometimes it’s not just the child’s fault: I then give tips to the parents or make contact with the school.”
She sees her position as one of the solutions to the overload of youth care and the long waiting lists. “I think I was able to ‘stop’ many children and young people from joining the waiting lists through conversations.”
Too much ‘disorder thinking’?
It raises the question whether there was not too much ‘disordered thinking’ in the past. According to Neef, parents often attach importance to a diagnosis because they then know what to do. Or because their child gets extra time for tests, to name just one example.
Vera Dekker also notices this. She is a psychologist at Molendrift and a youth practice assistant in Bedum. A diagnosis can be helpful, she acknowledges. “But it doesn’t tell you what to do with that child next. There are many nuances to diagnoses and no two children are the same.”
Wetterauw also recognizes the diagnostic pressure. But, he says, diagnosis was also necessary until 2015. Because without a diagnosis you could not start offering help through the health insurer. After all, how else would such a health insurer know whether the money was being spent on care that was really necessary? “It is a well-intentioned system that grew in the wrong direction.”
By the way, not all municipalities – which have been responsible for youth care since the Youth Act – still have a diagnosis obligation, and “you can just do what is necessary,” says Wetterauw.
“More and more municipalities are seeing that youth practice assistants are working. Through research we show what the active elements are. I predict that this will largely depend on the space we give professionals to do what they believe is appropriate. Bringing professionals who were doing their thing somewhere at the back of the healthcare system to the fore and allowing them to apply their knowledge there freely and unhindered.”