ABSTRACT
Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.
Subject(s)
Child Abuse/psychology , Child Welfare , Communication Barriers , Cultural Competency/education , Emigrants and Immigrants/psychology , Adolescent , Child , Cultural Diversity , HumansABSTRACT
Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.
Subject(s)
Child Abuse/psychology , Child Abuse/therapy , Mental Health Services/statistics & numerical data , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Adolescent , Child , Child Abuse/statistics & numerical data , Child, Preschool , Female , Germany , Health Services Accessibility/statistics & numerical data , Humans , Interview, Psychological , Male , Psychotherapy/statistics & numerical data , Risk Factors , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Utilization Review/statistics & numerical dataABSTRACT
The objective of this study was to compare structured case management (CM) to usual care (UC) for helping victims of child abuse and neglect (CAN) with mental disorders access evidence-based treatment (EBT). N=121 children and adolescents aged 4-17 with a history of CAN and a current mental disorder were recruited in three German states in a multi-center parallel group trial. They were randomly assigned, stratified by study site and level of psychosocial functioning, to receive CM additionally to UC or only UC. CM was delivered by trained professionals and volunteers, most of them affiliated to local child welfare agencies or NGOs. UC comprised child welfare services typically delivered in Germany. The primary outcome was EBT utilization after 6 months. Secondary outcome was the time until commencement of EBT. Outcomes were determined by semi-structured clinical interviews with assessors blinded to group allocation. Predictors of access to EBT and barriers to utilization of treatment were analyzed. The intent to treat analysis showed that after 6 months 23 of 60 participants recruited to CM (38%) and 19 of 61 participants recruited to UC (31%) were using EBT, χ2 (1, N=121)=0.689, p=.261. Female gender, out-of-home placement, and home state were significant predictors of access to EBT. Less than 40% of participants across both groups were successfully referred to EBT. Access to EBT seems to be in part due to system-level barriers, namely lack of implementation of EBT in community settings. TRIAL REGISTRATION: DRKS00003979 German Clinical Trials Register.
Subject(s)
Case Management , Child Abuse/psychology , Child Health Services/statistics & numerical data , Health Services Accessibility , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Adolescent , Child , Child Abuse/therapy , Child Welfare , Evidence-Based Practice , Female , Germany , Humans , Intention to Treat Analysis , Kaplan-Meier Estimate , Male , Mental Disorders/etiology , Sex FactorsABSTRACT
BACKGROUND: Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood. OBJECTIVES: This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN. METHODS: From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews. RESULTS: Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment. CONCLUSIONS: The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.
