Mapping evidence-based interventions to the care of unaccompanied minor refugees using a group formulation approach.

BACKGROUND: How we adapt treatment algorithms to complex, clinically untested, difficult-to-engage patient groups without losing evidence base in everyday practice is a clinical challenge. Here we describe process and reasoning for fast, pragmatic, context-relevant and service-based adaptations of a group intervention for unaccompanied minor asylum seekers (UASC) arriving in Europe. We employed a distillation-matching model and deployment-focused process in a mixed-method, top-down (theory-driven) and bottom-up (participant-informed) approach. Prevalence of mental disorders amongst UASC is extremely high. They also represent a marginalised and hard-to-engage group with limited evidence for effective treatments. METHOD: Content and process adaptations followed four steps: (1) descriptive local group characterisation and theoretical formulation of problems; (2) initial adaptation of evidenced treatment, based on problem-to-component grid; (3) iterative adaptation using triangulated feedback; and (4) small-scale pilot evaluation. RESULTS: Based on evidence and participant feedback, adaptations included minimising verbal demands, facilitating in-session inductive learning, fostering social connectedness via games, enhancing problem-solving skills, accounting for multi-traumatisation, uncertainty and deportation. Quantitative evaluation suggested improved feasibility, with increased attendance, low drop-out and symptom improvement on depression and trauma scores. CONCLUSIONS: By describing the principles under-pinning development of a group intervention for severely traumatised UASC, we contribute to the literature supporting dynamic adaptations of psychological interventions, without losing reference to evidence base. Complex and difficult-to-reach clinical groups are often those in most need of care, yet least researched and most affected by inequality of care. Pragmatic adaptations of proven programs are often necessary to increase feasibility.

[Clinical diagnostics of psycho-social and cognitive standard of performance in youth with mental disabilities.] / Diagnostik des psychosozialen und kognitiven Entwicklungsstandes bei Intelligenzminderung im Kindes- und Jugendalter.

Clinical diagnostics of psycho-social and cognitive standard of performance in youth with mental disabilities. Abstract. The clinical diagnostics of cognitive limitations and the resulting problems of social development occurring in childhood and adolescence are essential for further stimulation as well as for possible treatment strategies for comorbid mental diseases. This complex process should be carried out on several levels and with different methods. The resulting praxis-oriented question is defined via the pros and cons of the current procedure for the recording of psycho-social and cognitive stage of development of young people with mental disabilities. The online-based research in relevant databases was conducted systematically and yielded 3,324 articles. After fully reviewing the disqualifying criteria, 30 procedures remained. Twenty-four procedures could be assigned to "tests of development and intelligence" and six to "observer rating and self-report methods". It becomes clear that the majority of treatments have been standardized for children and adolescents of average intelligence. Meaning, only inaccurate information regarding the participation of children and adolescents with intelligence impairments in the standardized sample were given. This goes hand in hand with qualifying criteria that were not tested in consideration of the needs of people with intelligence impairment. Despite the current unsatisfactory situation, there is a demand for diagnostic instruments of the psycho-social and cognitive standard of performance in youth with mental disabilities. Currently, K-ABC II and ADOS-2 are recommended in combination with the observer rating methods ADI-R, VFE, and SRS.