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Psychiatry in Europe
Children and Adolescents in German Youth Welfare Institutions
a report by
Marc Schmid
Department of Child and Adolescent Psychiatry, University of Basel
The number of children and adolescents living in German residential
Abstract group homes remains relatively constant at around 60,000.
1
Multiple
Multiple psychosocial risk factors and traumatic life events are risk factors such as poverty, broken homes, neglect, sexual and
common in children and adolescents in youth welfare, especially in physical abuse, discontinuous relationships and genetic factors have an
residential care. Therefore, children and adolescents in youth welfare impact on the mental health of children and adolescents in residential
institutions are a high-risk population with regard to the development and foster care,
2–4
and 50–80% of children in group homes have had
of severe mental disorders. This paper gives an overview of the traumatic life experiences.
5,6
A German study that obtained
prevalence of behavioural and emotional symptoms and mental information from counsellors on a representative sample of 80
disorders in a German residential care population and compares these residential care children and adolescents showed that 75% had
findings with prevalence rates in other European countries. It also suffered at least one traumatic life event.
7
assesses the shortfall between the mental health needs of this high-
risk population and the treatment options available to them. The The upgrading of outpatient social services has indirectly contributed
international prevalence rates findings differ, from 44 to 96%. Most to a worsening of the situation in residential care institutions
studies with larger samples report a prevalence between 60 and 70%. because only children with the greatest psychosocial burden and
The most frequent diagnoses among children and adolescents in severe psychopathological symptoms are given expensive residential
residential care were severe externalising disorders but a high co- care placements. Children and adolescents with adverse family
morbidity with internalising disorders can be observed. The paper also backgrounds are at a very high risk of developing a chronic mental
describes the needs of this population from the perspective of child disorder, with subsequent impairment of their psychosocial
and adolescent psychiatry and psychotherapy and innovative functioning, for example going on to school failure, unemployment or
treatment options in this field. Relevant treatment concepts are a criminal career.
8,9
In follow-up studies, 19% of children had been
outlined, and the paper calls for improved psychiatric liaison services placed in three or more different foster families or institutions.
7,10
within the child welfare system to provide successful diagnostic and Moving between placements and the repeated breakdown of youth
therapeutic services, as well as suggestions to assist social services and welfare measures may worsen the prognosis because of the
professional training and management. detrimental effects of the loss of attachment figures on psychosocial
development. Twenty per cent of children and adolescents in Germany
Key words leave their residential placement within the first year.
11
Children, adolescents, mental health needs, residential group homes,
youth welfare Research into the Outcome of Residential Group Homes
Research in the field of youth welfare in Germany is limited, and few
Disclosure: The author has no conflicts of interest to declare. studies have evaluated the outcome of ambulant and residential youth
welfare interventions.
12–15
The Jugendhilfe-Effekte-Studie (JES)
16
and
Received: 9 April 2008 Accepted: 26 May 2008 the Evaluation Erzieherischer Hilfen (EVAS)
17
study are exceptions. Both
studies revealed beneficial effects of residential group home
Correspondence: Department of Child and Adolescent Psychiatry, placement (i.e. reduction of syndromes and an improvement of
University of Basel, Schaffhauserrheinweg 55, Ch-4058 Basel. scholastic achievements and psychosocial functioning, etc.). The
E:
marc.schmid@upkbs.ch authors showed that a residential placement takes some time to
develop positive effects, and that the improvement is greater for
children than for their parents.
There are indications that marked psychopathology and severe
Marc Schmid is a Psychologist, Cognitive Behavioural
Therapist and Systemic Family Therapist. He is also a
delinquency have an unfavourable influence on the outcome of group
Senior Researcher in the fields of child and adolescent
home placements.
18,19
In the long term, many residential care-leavers
residential care and special schools, co-operation between
have adverse outcomes in adulthood and are more likely to become
youth welfare institutions and child and adolescent
psychiatry, personality disorders, traumatised children and unemployed or homeless, fall pregnant as teenagers and be convicted
deliberate self-harm.
of a crime. They are also much less likely to attain a high social class.
20
The first cost–benefit analysis of residential care in group homes
21,22
(calculated on the basis of the JES) suggested that that €1 invested in
10 © TOUCH BRIEFINGS 2008
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