Improving cooperation between residential care institutions and child and adolescent psychiatry
The number of children and adolescents living in residential group homes in Europe is high, for example in Germany at about 70,000. Multiple risk factors, such as poverty, broken homes, neglect, sexual and physical abuse, discontinuous relationships and genetic factors have an impact on the mental health of children and adolescents in residential care. Within the general population the rate of mental health problems in children is about 20-25%. However, the rate is about three times higher in residential care populations. Studies investigating the prevalence of mental health problems in residential care populations indicate that conduct disorder (CD) is one of the most frequent diagnoses. CD is characterized by repetitive and chronic aggressive and antisocial behavior and severe problems in emotion regulation and impulse control. A variety of implications exist, some of the most major problems are school refusal, social communication problems, difficulties with reintegrating into work life or legal involvements. Frequently associated comorbid psychiatric disorders such as depression, anxiety disorders and ADHD oftentimes further aggravate adolescents’ development. Thus, effective intervention approaches that target the improvement of interpersonal functioning, anger management and social skills are needed.
FemNAT-CD will particularly focus on considering specific needs of CD girls in order to implement effective intervention approaches in cooperation between residential care institutions and child and adolescent psychiatry. In addition to the goal to reduce behavioural and emotional problems in severely affected girls with CD living in residential care institutions this program additionally aims to strengthen the chance of continuous care and to avoid repeated movement placements.
In addition, continuous counseling and supervising residential care teams on how to deal with adolescents’ aggression and emotional outbursts, rule breaking, unit-destructive and life-threatening behavior strongly is recommended. In this vein, it is most important to build a secure milieu and to teach social workers involved in the patients’ care on how to interpret misbehaviour in terms of child and adolescent psychiatric symptoms and, from this, to develop concrete solutions with the residential care teams addressing these symptoms.
The planned implementation of an integrative intervention approach comprising DBT-oriented group intervention intends to specifically enhance emotion regulation capacities and empathic skills with the goal to enable CD children and adolescents to appropriately deal with daily-life demands and to thus enhance psychosocial adjustment. In addition, training and supervision of the residential care team aims to support professionals in order to better cope with difficult to manage behavior and to alleviate stress and burden, not only in affected adolescents but also in staff workers.
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