Mehrfachdiagnosen bei Schweizer Heimjugendlichen

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

[Interventions for Children and Adolescents Living in Foster or Institutional Care - A Systematic Review]

Children or adolescents living in foster or institutional care received so far insufficient consideration in therapy intervention research. At the same time, they are a high-risk group for developing mental illness. The aim of this systematic review is to record evidence-based psychotherapeutic interventions of the past 15 years on a national and international level that address children and young people living in foster care and youth welfare institutions and their mental health. Through a systematic literature research, interventions for the target group described were identified and analyzed about their specificity and evidence. From 170 publications, ten interventions with sufficient evidence could be included in the present analysis. The result of the current literature research shows that further specialized psychiatric-psychotherapeutic interventions for children in foster care and youth welfare institutions are necessary. Regarding the transferability to the German youth welfare and health system, cross-system and interdisciplinary cooperation is needed. Hereafter further research is required to establish specific and evidence-based intervention approaches.

[Attachment Representations and Burnout of Social Workers]

This paper examines the distribution of attachment representations among social work professionals using the Adult Attachment Projective Picture System (AAP; George, West, Pettem, 1997). In this sample, the influence of attachment on the occurrence of burnout syndrome is investigated, as this is considered as a trigger for further mental and physical illnesses. For this purpose, 79 social pedagogical professionals from the German-speaking part of Switzerland were examined over four time points using the Burnout Screening Scales - BOSS. The following distribution of attachment representations was found using the AAP: 25.3 % secure, 38.0 % insecure dismissing, 27.8 % insecure preoccupied, and 8.9 % unresolved trauma. This distribution differs significantly from other samples of non-clinical adults and psychotherapists. Interestingly, no general associations emerged between insecure attachment representations and burnout. A significant positive correlation was shown between "unresolved trauma" and the suspected diagnosis of "burnout occupation". The so far few but contradictory empirical findings on attachment representations among professionals require further research activities as well as an intensive sensitization with regard to attachment theory in basic and further training courses and a further establishment of self-awareness and supervision components in all psychosocial fields of work.

Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies

While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3-17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6-66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33-2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.

Misshandlungs- und Vernachlässigungserfahrungen in der Kindheit: Ein Risikofaktor für die soziale Teilhabe ehemals außerfamiliär platzierter junger Erwachsener

Zusammenfassung. Theoretischer Hintergrund: Eine Reihe von Studien zeigen soziale Folgen von Misshandlung und Vernachlässigung in der Kindheit im weiteren Lebenslauf. Fragestellung: Diese Studie zielt darauf ab, die langfristigen Auswirkungen von Misshandlungs- und Vernachlässigungserfahrungen auf die soziale Teilhabe in einer Stichprobe von ehemals fremdplatzierten jungen Erwachsenen in der Schweiz zu untersuchen. Methode: Im Rahmen der Studie wurden 218 ehemals fremdplatzierte junge Erwachsene ( MAlter=26.1, 32.6 % weiblich) mit einer psychometrischen Testbatterie befragt. Dabei wurden Misshandlungserfahrungen in der Kindheit erfasst sowie die soziale Teilhabe bezüglich psychischer Gesundheit, Legalbewährung, sozio-ökonomische Lage und Beziehungen untersucht. Ergebnisse: Die Ergebnisse zeigen die hohe Prävalenz und negativen Folgen von kumulierten Misshandlungserfahrungen bei ehemals fremdplatzierten jungen Menschen. Eine höhere Anzahl von Misshandlungserfahrungen ging mit signifikant mehr Problemen in gesundheitlichen, finanziellen und sozialen Lebensbereichen einher. Diskussion und Schlussfolgerung: Die gravierenden Folgen von Misshandlungserfahrungen in der Kindheit unterstreichen die Bedeutung der Prävention und frühzeitigen Intervention. Sie zeigen aber auch, dass viele schwer betroffene junge Menschen neben therapeutischen auch konkrete und lebensweltorientierte Hilfen benötigen, um ihre Entwicklungsaufgaben adäquat zu bewältigen und erfolgreich an der Gesellschaft teilzuhaben.

Was wird aus Care Leavern?

Zusammenfassung. Theoretischer Hintergrund: Verschiedene Studien zeigen auf, dass ehemals ausserfamiliär platzierte Jugendliche, die viele biologische und psychosoziale Risikofaktoren akkumulieren, im weiteren Lebenslauf häufig eine geringere soziale Teilhabe aufweisen. Fragestellung: Dieser Themenschwerpunkt berichtet von einer Längsschnittstudie (JAEL – Jugendhilfe aus Erfahrung lernen) mit ehemals fremdplatzierten jungen Erwachsenen, die einer Hochrisikostichprobe zugeordnet werden können. Methode: Die Studie kombiniert für ihre Forschungsfragen prospektive und retrospektive Aspekte sowie qualitativ und quantitativ erhobene Daten. Ergebnisse: Der Themenschwerpunkt gibt sowohl eine kurze Einführung in die Methoden und die Rekrutierung der Stichprobe als auch einen Einblick in drei ausgewählte Themen, die in den drei Beiträgen dieses Themenschwerpunktes behandelt werden. Der erste Beitrag berichtet über die Ergebnisse zum Verlauf der psychischen Probleme vom Jugend- bis ins junge Erwachsenenalter. Der zweite Beitrag befasst sich mit Misshandlung und Vernachlässigung in der Kindheit als Risikofaktor für die soziale Teilhabe im jungen Erwachsenenalter, wie z. B. Arbeitslosigkeit, Legalbewährung, sozioökonomische Lage, psychische Gesundheit oder auch Beziehungsfähigkeit. Diese negativen Auswirkungen können durch Selbstwirksamkeitserfahrungen abgemildert werden. Der dritte Beitrag beinhaltet einen der bisher weniger beachteter Längsschnittstudienaspekte, nämlich die Risikofaktoren für eine Persönlichkeitsstörung in einer Hochrisikostichprobe sowie deren Stabilität. Diskussion und Schlussfolgerung: Auf die Bedeutung und Implikationen für Interventionen und Jugendhilfepolitik einerseits und die Forschung in diesem Feld andererseits wird eingegangen.

Shared residential placement for child welfare and juvenile justice youth: current treatment needs and risk of adult criminal conviction

BACKGROUND

Although child welfare youth and juvenile offenders in residential care have different judicial placement reasons, there seems to be overlap in their demographic and psychosocial backgrounds. This could raise the question whether these adolescents should be placed in strictly separated institutions based on their judicial title (civil or criminal law) or together based on their needs. As systematic knowledge on the effects of shared placement of these groups is limited, the aim of the current paper is to examine the demographic, crime-related and psychosocial characteristics of child welfare and juvenile justice youths in shared residential care and subsequently examine its relationship with offending behavior in adulthood.

METHODS

The sample was drawn from the Swiss study for clarification and goal-attainment in youth welfare and juvenile justice institutions (MAZ.) and consisted 354 juveniles (252 child welfare, 102 juvenile justice; 223 boys, 131 girls) between 10 and 18 years. Mental health problems were assessed with the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), official adult criminal conviction data up to 10 years later was obtained from the Swiss Federal Office of Statistics. Three sets of logistic regressions were conducted investigating any, violent and non-violent convictions.

RESULTS

Univariate results showed that that the child welfare sample included more females, more juveniles with the Swiss nationality, and was younger at the time of assessment and at first placement compared to the juvenile justice sample. Furthermore, child welfare youths showed less alcohol/drug use problems and offending behavior than their juvenile justice counterparts. Unadjusted models demonstrated that committing authority predicted adult criminal convictions, but that this distinction disappeared when it was controlled for demographic, crime-related and psychosocial factors. Gender and time at risk were found to be related to adult conviction in all three models. In addition, alcohol/drug use problems were risk factors for general, previous convictions for violent, and traumatic experiences for non-violent convictions in adulthood.

CONCLUSIONS

Our results support the approach of placement in residential care institutions based on treatment needs instead of on judicial title. Special attention should be devoted to trauma informed care and substance use coping. However, more research is needed.

The Stress of Caring-Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers

Background: Professional caregivers in youth residential care institutions experience frequent verbal and physical aggression as well as multiple stressors as part of their everyday work, leading to high levels of burnout and staff turnover. Resilience might buffer against psychophysiological stress response and therefore be crucial for well-being in professional caregivers. Objectives: We aimed to investigate if measures related to resilience [sense of coherence (SoC), self-efficacy and self-care] and attachment security of caregivers were cross-sectionally associated with stress markers in hair samples [cortisol and dehydroepiandrosterone (DHEA)]. Method: Participants (n = 134; 64.2% women) reported on individual resilience measures and provided hair samples for cortisol and DHEA assays. Attachment was assessed in a subsample using the Adult Attachment Projective Picture System (AAP, n = 69). Linear regression models were fitted to estimate the association between resilience measures and the Cortisol:DHEA ratio, cortisol and DHEA, controlling for gender and age. Results: SoC was associated with a lower Cortisol:DHEA ratio (β = -0.36, p < 0.001), driven by a positive association between SoC and DHEA levels (β = 0.28, p = 0.002). Self-care was also associated with lower Cortisol:DHEA ratios (β = -0.24, p = 0.005), due to self-care being associated with higher DHEA (β = 0.21, p = 0.016). HPA-axis measures were not associated with self-efficacy nor with attachment patterns in a subsample. Conclusions: Our findings imply that youth residential care institutions might benefit from programs focusing on enhancing SoC and self-care practices. Fostering a meaningful, comprehensible and manageable professional climate in caregiving environments and implementing self-care in routine practices might enhance not only well-being but also physical health of professional caregivers and in this way buffer adverse health effects of chronic stressors.

[The Influence of Personal Resources on Job Satisfaction Among Professionals in the Inpatient Care of Burdened Children and Adolescents]

The Influence of Personal Resources on Job Satisfaction Among Professionals in the Inpatient Care of Burdened Children and Adolescents Professionals in the inpatient care of burdened and partially traumatized children and adolescents are confronted with high demands in their everyday work. If these professionals do not have the necessary resources to carry out their work, their job satisfaction can be affected negatively. In the present study, the connections between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction were investigated on a sample of N = 543 professionals working in the (inpatient) care of children and adolescents. The survey was conducted as part of the accompanying research of an online course called "Trauma informed Care". Correlations as well as a multiple regression were calculated for the connections between personal resources and job satisfaction. Moderate to strong correlations were identified between personal resources and job satisfaction. The regression model revealed self-efficacy, followed by self-care, to be the most important predictor of job satisfaction. Less importance could be ascribed to emotional competence as a predictor of job satisfaction. Action competence showed no effects in the model. The results indicate the importance of personal resources for job satisfaction. These should be promoted in a targeted manner to increase job satisfaction and thus counteract the tendency of fluctuation and shortage of professionals in the area of child and youth welfare and thereby ensuring high quality care of the vulnerable population.

[Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized]

Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized Previous research proved a greater prevalence of mental health problems among children in residential youth care. In the present study, based on the KiGGS study, the prevalence of mental health problems is analyzed using the German version of the Strengths and Difficulties Questionnaire (SDQ) for those children and adolescents seeking youth welfare services, compared to those children not seeking youth welfare service. The possible differences between these two groups were tested using multivariate regression. The study covers two survey periods of KiGGS at intervals of six years. The result shows a significantly higher prevalence for mental health problems in adolescents seeking youth welfare services. The regression analysis shows that the association with mental health problems in these children persists even after adjusting for socioeconomic and demographic factors. There are hardly any changes in the results within the trend analysis. This indicates a high temporal stability of the association.

Hypothalamic-pituitary-adrenal axis activation in a high-risk sample of children, adolescents and young adults in residential youth care - Associations with adverse childhood experiences and mental health problems

Adverse childhood experiences (ACEs) lead to devastating long-term health consequences that are associated with a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Children and adolescents living in institutional care have an increased risk to experience ACEs, particularly linked to missing continuity of care, and a higher risk for consequences of ACEs such as mental disorders. In order to improve the overall quality of care, it is important to better understand the stress-physiology of this high-risk sample and to identify specific stressors linked to adverse outcomes. Therefore, we assessed ACEs due to missing continuity of care and their association with hair cortisol and DHEA levels in children, adolescents and young adults in institutional care. Results show that ACEs resulting from the family of origin, in detail maternal mental illness, and ACEs due to out-of-home placement, namely frequent change of caregivers, are associated with HPA axis over-activation. HPA axis activation is associated with enhanced mental health problems. These results point towards an association between continuity of care and the stress system of children and adolescents in this high-risk sample. Care concepts that focus on continuity of care might help to reduce these physiological alterations and devastating long-term consequences following ACEs.

Predictive factors for changes in quality of life among children and adolescents in youth welfare institutions

PURPOSE

Children and adolescents living in youth welfare institutions often have a below average quality of life (QoL), for reasons that include developmental difficulties, history of traumatic experiences, and mental disorders. Youth welfare measures are needed that would have a positive impact, but there is a lack of longitudinal research on which measures are most effective. This study investigated what factors are associated with an improvement in QoL during residential stay.

METHODS

Residents of youth care facilities in Switzerland and their professional caregivers completed questionnaires that addressed QoL, psychopathology, and experience of traumatic events at two time points. In addition, information regarding mental disorders was obtained through structured clinical interviews. Analyses were conducted on the data obtained from 204 respondents aged 11-18 years. Comparisons with a school sample were conducted.

RESULTS

Compared to a school sample, a majority of participants rated their QoL equal, whereas their caregivers rated it as lower. Factors predictive of a poorer QoL were high levels of internalizing and externalizing psychopathology, presence of co-morbidities, and female gender. At the second assessment, the caregivers reported a small improvement, which was associated with reductions in both internalizing and externalizing psychopathology.

CONCLUSIONS

The finding that a reduction in severity of psychopathology may result in an improvement in QoL underlines the importance of providing professional support for mentally ill residents of youth welfare institutions. Further research is needed to determine the causality of this association.

Affective dysregulation in childhood - optimizing prevention and treatment: protocol of three randomized controlled trials in the ADOPT study

BACKGROUND

The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden.

METHODS

The ADOPT (Affective Dysregulation - Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis).

DISCUSSION

The results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder.

TRIAL REGISTRATION

Trial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963 . Registered 27 June 2018. Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317 . Registered 27 September 2018. Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581 . Registered 04 July 2018.

Kindesmisshandlung bei Pflegekindern

Zusammenfassung. Theoretischer Hintergrund: Pflegekinder erleben signifikant mehr Misshandlung und Vernachlässigung als andere Kinder und leiden häufiger unter deren langfristigen Auswirkungen. Methode: In dem vom BMBF geförderten Forschungsprojekt GROW&TREAT wurden 94 Pflegekinder hinsichtlich der Auswirkungen unterschiedlicher Misshandlungsformen auf ihre Entwicklung untersucht. Als Vergleichsstichprobe dienten 157 in der Herkunftsfamilie lebende Kinder ohne bekannte Misshandlungserfahrung. Mithilfe standardisierter Verfahren wurden emotionale und Verhaltensprobleme, die Beziehungsgestaltung zwischen den Kindern und ihren (Pflege–) Eltern, sowie die kognitive Entwicklung der Kinder erfasst. Ergebnisse: Die Ergebnisse zeigen wie erwartet, dass Pflegekinder eine ungünstigere Entwicklung aufweisen und dass unterschiedliche Misshandlungsformen spezifische Auswirkungen auf die kognitive Entwicklung der Kinder haben. Diskussion: Die Limitationen der Studie und Implikationen für weitere Forschungsansätze werden kritisch reflektiert.

[Success Factors and Stumbling Blocks in the Cooperation with Child and Adolescent Psychiatry/Psychotherapy from the Perspective of Social Pedagogues]

Success Factors and Stumbling Blocks in the Cooperation with Child and Adolescent Psychiatry/Psychotherapy from the Perspective of Social Pedagogues In numerous current studies, experts describe a need for improved cooperation between employees of youth welfare and child and adolescent psychiatry/-psychotherapy. The present study investigates how social pedagogues working in youth welfare institutions perceive psychiatrists or psychologists working in child and adolescent psychiatry. Benefits and difficulties of the cooperation are described and potential areas of improvement as perceived by youth welfare employees are identified. The study presents quantitative and qualitative data and pursues a mixed-method approach. The qualitative evaluation is based on the content structuring qualitative content analysis according to Kuckartz (2012) and is complemented by descriptive data. The results are based on the responses of 221 social pedagogues in Switzerland. While 97.7 % of respondents perceive interdisciplinary collaborations for children with high psychological stress as ideal, they also mention various barriers that hinder effective and efficient cooperation. Many social pedagogues wish for the field of child and adolescent psychiatry to show a greater interest in their job profile, as well as more appreciation for the demanding work that they perform. Clarification of roles and responsibilities, a better flow of information and a direct person of contact are also deemed important aspects to improve upon. The study suggests practical approaches for a more effective cooperation.

Beurteilung von Kindern und Jugendlichen in Erziehungshilfen mit dem Kompetenzanalyseverfahren (KANN)

Zusammenfassung. Das Kompetenzanalyseverfahren (KANN) ist ein Fremdbeurteilungsverfahren für Eltern und pädagogische Fachkräfte zur Beurteilung beobachtbarer Kompetenzen von Kindern und Jugendlichen. In der Studie wird untersucht, ob, und wenn ja, inwiefern sich die Unterschiede zwischen den zwei Normstichproben (Schulnorm/Elternurteil vs. Kinder- und Jugendhilfe-Norm/Urteil pädagogischer Fachkräfte) durch (1) die Reliabilität des Messinstruments, (2) systematische Beurteilertendenzen und/oder (3) Kompetenzdefizite von Kindern und Jugendlichen in Erziehungshilfen erklären lassen. Hierzu wurden die Intra-/Interrater-Reliabilität und -Übereinstimmung an vier Stichproben aus dem Bereich der Erziehungshilfen analysiert: (A) Pädagoge/-in A – A (Test-Retest), n = 153; (B) Pädagoge/-in A – B, n = 169; (C) Mutter–Vater, n = 26 und (D) Pädagoge/-in – Elternteil, n = 136. Die Ergebnisse weisen auf eine gute Intra-/Interrater-Reliabilität und eine akzeptable Übereinstimmung im Urteil pädagogischer Fachkräfte hin. Zwischen unterschiedlichen Beurteilertypen (Pädagoge/-in – Elternteil), lässt sich eine deutlich niedrigere Interrater-Reliabilität und -Übereinstimmung feststellen. Der Vergleich des Elternurteils mit den beiden Normstichproben verdeutlicht die unterdurchschnittlichen KANN-Werte von Kindern und Jugendlichen in Erziehungshilfen. Eine Überschätzungstendenz der Eltern ist wahrscheinlich.

Bindungsauffälligkeiten und psychische Belastung bei Kindern aus der Pflegekinderhilfe und Heimerziehung

Zusammenfassung. Symptome von Bindungsstörungen, auch in Verbindung zu anderen psychischen Symptomen, sind von hoher Relevanz für die Hilfeplanung in der Kinder- und Jugendhilfe. Dennoch wurde diesen im Bereich der epidemiologischen Forschung in der Kinder- und Jugendhilfe bisher kaum die notwendige Beachtung geschenkt. Vor diesem Hintergrund wurden 116 Heimkinder, 276 Pflegekinder und 339 Kinder aus der Allgemeinbevölkerung mit der Child Behavior Checklist (CBCL) und dem Relationship Problems Questionnaire (RPQ) untersucht. Heimkinder erreichten in der CBCL signifikant höhere Werte als Pflegekinder. Die Wahrscheinlichkeit für einen auffälligen Wert in der CBCL war bei Heimkindern 20.96-mal und bei Pflegekindern 8.02-mal so hoch wie in der Allgemeinbevölkerung. Im RPQ zeigten sich keine Unterscheide zwischen Heim- und Pflegekindern. Die Wahrscheinlichkeit für einen auffälligen Wert im RPQ war bei Heimkindern 25.29-mal und bei Pflegekindern 19.37-mal so hoch wie in der Allgemeinbevölkerung. Eine Abklärung der psychischen Belastung und Bindungsproblematik des Kindes sowie eine darauf abgestimmte Hilfeplanung sind wesentlich, um einer Überforderung des Kindes und der Fürsorgeperson vorzubeugen und dem Kind korrigierende Bindungserfahrungen zu ermöglichen.

Komorbide Angststörungen bei Störungen des Sozialverhaltens

Zusammenfassung. Obwohl Angststörungen (AS) häufig komorbid mit einer Störung des Sozialverhaltens (SSV) auftreten, wurde diese Komorbidität in der Forschung weitgehend vernachlässigt. Komorbide AS wirken sich in Studien sowohl positiv als auch negativ auf den Verlauf einer SSV aus. Diese Studie zielt darauf ab, Heranwachsende mit einer SSV mit und ohne AS hinsichtlich psychischer Belastung, traumatischen Erlebnissen, psychopathischen Persönlichkeitstraits und Legalbewährung zu untersuchen. 207 Heranwachsende mit einer SSV (9 – 25 Jahre; 73.4 % männlich; SSV: N = 180, SSV und AS: N = 27), die zum Zeitpunkt der Untersuchung in Jugendhilfeeinrichtungen lebten, konnten eingeschlossen werden. Es wurden strukturierte klinische Interviews und eine psychometrische Testbatterie eingesetzt. Die Resultate zeigen, dass die Gruppe mit SSV und AS signifikant weniger externalisierende und mehr internalisierende Symptome sowie traumatische Erlebnisse aufweisen. Bezüglich psychopathischer Persönlichkeitsmerkmale und Verurteilungen (>50 % in beiden Gruppen) ergaben sich keine signifikanten Gruppenunterschiede. Die Ergebnisse legen nahe, dass die Ausprägung der SSV für die Kriminalitätsentwicklung bedeutsamer und die spezifische Komorbidität von AS aber doch ätiologisch und symptomatisch von großem Interesse ist. Diese sollte deshalb mit Längsschnittstudien und Therapieprozessanalysen intensiver beforscht werden.

Diagnostic performance and optimal cut-off scores of the Massachusetts youth screening instrument-second version in a sample of Swiss youths in welfare and juvenile justice institutions

BACKGROUND

There is a growing consensus about the importance of mental health screening of youths in welfare and juvenile justice institutions. The Massachusetts Youth Screening Instrument-second version (MAYSI-2) was specifically designed, normed and validated to assist juvenile justice facilities in the United States of America (USA), in identifying youths with potential emotional or behavioral problems. However, it is not known if the USA norm-based cut-off scores can be used in Switzerland. Therefore, the primary purpose of the current study was to estimate the diagnostic performance and optimal cut-off scores of the MAYSI-2 in a sample of Swiss youths in welfare and juvenile justice institutions. As the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample of the current study and consequently we could estimate the diagnostic performance and the optimal cut-off scores of the MAYSI-2 for the language regions separately. The other main purpose of the current study was to identify potential gender differences in the diagnostic performance and optimal cut-off scores.

METHODS

Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions (drawn from the French-, German- and Italian-speaking parts of Switzerland). The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). The MAYSI-2 scores were submitted into Receiver-Operating Characteristic (ROC) analyses to estimate the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2.

RESULTS

The ROC analyses revealed that nearly all homotypic mappings of MAYSI-2 scales onto (cluster of) psychiatric disorders revealed above chance level accuracy. The optimal 'caution' cut-off scores derived from the ROC curve for predicting (cluster of) psychiatric disorders were, for several MAYSI-2 scales, comparable to the USA norm-based 'caution' cut-off scores. For some MAYSI-2 scales, however, higher optimal 'caution' cut-off scores were found.

CONCLUSIONS

With adjusted optimal 'caution' cut-off scores, the MAYSI-2 screens potential emotional or behavioral problems well in a sample of Swiss youths in welfare and juvenile justice institutions. However, as for choosing the optimal 'caution' cut off score for the MAYSI-2, both language as well as gender seems to be of importance. The results of this study point to a compelling need to test the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2 more elaborately in larger differentiated language samples in Europe.

Ability of the Child Behavior Checklist-Dysregulation Profile and the Youth Self Report-Dysregulation Profile to identify serious psychopathology and association with correlated problems in high-risk children and adolescents

BACKGROUND

The current analyses examined whether the dysregulation profile (DP) 1) could be used to identify children and adolescents at high risk for complex and serious psychopathology and 2) was correlated to other emotional and behavioral problems (such as delinquent behavior or suicide ideation). DP was assessed using both the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) in a residential care sample.

METHODS

Children and adolescents (N=374) aged 10-18 years living in residential care in Switzerland completed the YSR, and their professional caregivers completed the CBCL. Participants meeting criteria for DP (T-score ≥67 on the anxious/‌depressed, attention problems, and aggressive behavior scales of the YSR/CBCL) were compared against those who did not for the presence of complex psychopathology (defined as the presence of both emotional and behavioral disorders), and also for the prevalence of several psychiatric diagnoses, suicidal ideation, traumatic experiences, delinquent behaviors, and problems related to quality of life.

RESULTS

The diagnostic criteria for CBCL-DP and YSR-DP were met by just 44 (11.8%) and 25 (6.7%) of participants. Only eight participants (2.1%) met the criteria on both instruments. Further analyses were conducted separately for the CBCL-DP and YSR-DP groups. DP was associated with complex psychopathology in only 34.4% of cases according to CBCL and in 60% of cases according to YSR. YSR-DP was somewhat more likely to be associated with psychiatric disorders and associated problems than was the CBCL-DP.

LIMITATIONS

Because of the relatively small overlap between the CBCL-DP and YSR-DP, analyses were conducted largely with different samples, likely contributing to the different results.

CONCLUSIONS

Despite a high rate of psychopathology in the population studied, both the YSR-DP and the CBCL-DP were able to detect only a small proportion of those with complex psychiatric disorders. This result questions the validity of YSR-DP and the CBCL-DP in detecting subjects with complex and serious psychopathology. It is possible that different screening instruments may be more effective.

Relationship between Massachusetts Youth Screening Instrument-second version and psychiatric disorders in youths in welfare and juvenile justice institutions in Switzerland

BACKGROUND

There is growing evidence that it is important to have well-standardized procedures for identifying the mental health needs of youths in welfare and juvenile justice institutions. One of the most widely used tools for mental health screening in the juvenile justice system is the Massachusetts Youth Screening Instrument-second version (MAYSI-2). To contribute to the body of research examining the utility of the MAYSI-2 as a mental health screening tool; the first objective of the current study was to examine the relationship between the MAYSI-2 and the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL) in a sample of Swiss youths in welfare and juvenile justice institutions using a cross-sectional design. Secondly, as the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample and consequently differences between the language regions were analyzed as well. The third objective was to examine gender differences in this relationship.

METHODS

Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions in Switzerland. The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). Binomial logistic regression analysis was used to predict (cluster of) psychiatric disorders from MAYSI-2 scales.

RESULTS

The regression analyses revealed that the MAYSI-2 scales generally related well to their corresponding homotypic (cluster of) psychiatric disorders. For example, the alcohol/drug use scale identified the presence of any substance use disorder and the suicide ideation scale identified youths reporting suicide ideation or suicide attempts. Several MAYSI-2 scales were also related to heterotypic (cluster of) psychiatric disorders. For example, the MAYSI-2 scale alcohol/drug use, was positively related to any disruptive disorder. Furthermore, the results revealed gender differences in the relationship between the MAYSI-2 and K-SADS-PL (e.g., in the boys' subsample no MAYSI-2 scale was significantly related to any affective disorder; whereas, in the girls' subsample the MAYSI-2 scales depressed-anxious and somatic complaints were significantly related to any affective disorder).

CONCLUSIONS

Overall, The MAYSI-2 seems to serve well as a first-stage screen to identify service needs for youths in welfare and juvenile justice institutions in Switzerland. Its effectiveness to identify the presence of (cluster of) psychiatric disorders differs between genders.

Professional caregiver's knowledge of self-reported delinquency in an adolescent sample in Swiss youth welfare and juvenile justice institutions

Since an important goal of the youth welfare system is to prevent troubled adolescents from committing acts of delinquency in future, professional caregivers need to possess accurate knowledge about past behaviors in order to implement appropriate interventions. As part of a comprehensive study on youth in state care, adolescents at 30 residential care facilities in Switzerland were surveyed about past acts of delinquency, and their responses were compared to those of their professional caregivers to see how well they correlated. A sample of 267 male and female adolescents aged 11-18years completed questionnaires about the frequency, nature, and seriousness of different types of offenses, while a designated caregiver for each resident completed a corresponding questionnaire. The majority of residents (86.1%) reported having committed at least one offense, which confirms the prevalence of problem behaviors in this population and the need for strategies to prevent it. The overall rate of agreement between the residents and their caregivers was 77.2%, with both parties reporting that the resident had committed at least one offense in 69.7% of cases, and both reporting that no offense had been committed in 7.5% of cases. Agreement was substantially higher for offenses that were serious than for those that were minor or moderate. Cohen's kappa reached slight to moderate values with regard to individual and categorized offenses. Seriousness scales of delinquency for self-reports and caregiver reports were moderately associated. While the overall rate of agreement between the residents and their caregivers was high, increasing it still further might lead to improvements in strategies for the prevention of recidivism.

On the incidence and prevalence of child maltreatment: a research agenda

Research on child maltreatment epidemiology has primarily been focused on population surveys with adult respondents. Far less attention has been paid to analyzing reported incidents of alleged child maltreatment and corresponding agency responses. This type of research is however indispensable to know how well a child protection system works and if the most vulnerable are identified and served. Notable findings of child maltreatment epidemiological research are summarized and directions for future studies discussed.

[The Relationship Between Burnout Symptoms and Work Satisfaction Among Child Welfare Workers in Residential Care]

Working in residential care is associated with high demands and high stress. As a result, employees may develop symptoms of burnout. These symptoms lead to absence from work and have a negative effect on the continuity and quality of the residential care. Until now, little is known about burnout risks in child welfare workers, although children and adolescents are especially dependent on continuous relationships and healthy caregivers. A better understanding of the relationship between burnout symptoms and work satisfaction may help to identify starting points for prevention and intervention. The present study assessed symptoms of burnout in a sample of 319 social education workers in residential care in Switzerland using the burnout-screening-scales (BOSS). Work satisfaction was assessed with a newly developed questionnaire based on concepts of trauma-sensitive care. The questionnaire was tested for reliability and factorial validity in the present study. In order to estimate the relationship between burnout symptoms and work satisfaction, correlations and relative risks were calculated. Almost one fifth (18 %) of the sample showed a risk of burnout. The principal component analysis of the questionnaire on work satisfaction revealed four factors: support by superiors, participation and transparency; communication and support within the team; gratification in the work; and institutional structures and resources. All four factors as well as the total score showed significant correlations with burnout symptoms. Among employees with a comparably lower work satisfaction, the risk of burnout was 5.4 times higher than among employees with a comparably higher work satisfaction. It is discussed how work satisfaction could be promoted and how, as a result, the quality and continuity of care for the children and adolescents could be improved.

[Placement of children and adolescents following seclusion and restraint actions–a study on family-court approvals of minors in youth welfare, child and adolescent psychiatry and jail according to Para. 1631 German Civil Code]

According to German law (Para. 1631b German Civil Code), the placement of children and adolescents following seclusion and restraint actions must be approved by a family court. We analyzed the family court data of a court district in Berlin (Tempelhof-Kreuzberg) concerning cases of “placement of minors” between 2008 and 2011. A total of 474 such procedures were discovered. After data clearing and correction of cases (e. g., because of emergency interventions of the youth welfare system taking children into custody according to Para. 42, German Civil Code VIII), 376 cases remained. Of these 376 procedures in the years 2008 to 2011, 127 cases concerned children and adolescents according to Para. 1631b German Civil Code, and 249 procedures were settled either by dismissal, withdrawal or by repealing the initial decision to place the child with restrain or seclusion by means of an interim order or by filing an appeal against the final decision. Of the 127 procedures, 68 concerned girls, who were on average slightly younger than boys (14.5 years vs. 15.1 years). In two thirds of the procedures, the children and adolescents were German citizens. The majority of youths involved were living at home at the time of the procedure, but in 15 % of the case the youths were homeless. Most of the adolescents were treated with restraint in child and adolescent psychiatry. The most frequently quoted reasons for seclusion were substance abuse, suicide risk and running away from home/being homeless.

Kinder- und Jugendpsychiatrie/Psychotherapie versus Kinder- und Jugendhilfe

Jugendhilfe und Kinder- und Jugendpsychiatrie/Psychotherapie besitzen eine unterschiedliche Tradition und werden durch unterschiedliche Berufsgruppen geprägt. Besonders deutlich zeigt sich dies im Verständnis und der Behandlungsbedürftigkeit von psychischen Störungen im Kindes- und Jugendalter. An dieser Unterschiedlichkeit der Professionen leidet die Kooperation zwischen beiden Bereichen erheblich. Zusätzlich unterscheiden sich beide Bereiche erheblich in ihren Forschungstraditionen und aktuellen Forschungsbemühungen. Die Bedeutung der Jugendhilfe wird durch die vielfältigen Vernetzungen mit den Bereichen „Schule”, „Justiz”, „Medizin” etc. unterstrichen.