Satisfaction with in-patient child and adolescent psychiatric treatment: development and psychometric properties of the BEST questionnaires for adolescents and for parents.

BACKGROUND: Interest in the assessment of patient satisfaction with in-patient psychiatric treatment has steadily increased and several measurement tools are available for the quantification of patients' experience. However, they are often uni-dimensional or focus mainly on therapeutic relationship and environment, and neglect other important issues such as information about treatment and participation. The BEST questionnaires were developed as comprehensive instruments that include items on all of the mentioned topics. The present study evaluates the psychometric properties of the BEST in a version for adolescents and for parents. Furthermore, the dimensionality of the satisfaction ratings is analyzed. METHOD: Descriptive statistics were applied to data of 1582 adolescents (mean age = 15.0 years, SD = 1.65; 62.4% female) and 1998 parents/guardians assessed in seven in-patient units across Germany. The factorial structure of the BEST questionnaires was determined by exploratory and confirmatory factor analyses, including a bifactor model. RESULTS: The psychometric quality of the scales was strong. Correlations with another assessment instrument of patient satisfaction were good to high, indicating good convergent validity. Exploratory factor analyses revealed three factors in adolescents that were labelled as: Therapeutic relationship, environment, and general satisfaction and treatment success. For parents, the same three factors could be distinguished. Confirmatory bifactor models suggested that the vast majority of variance was accounted for by the general factor; the three specific factors provided some additional information. Agreement between the subscales of adolescents and their parents was only moderate. Parents were usually more satisfied. CONCLUSIONS: The BEST questionnaires can be considered as reliable and valid instruments to not only assess the "classical" aspects of patient satisfaction, but to also assess newer fundamental topics such as children's rights and treatment participation. For scientific usage, the total score seems superior because of the high explained variance by the general factor, but the subscale scores provide further information. The use of single items seems advantageous for quality management purposes.

[Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect]. / Erfahrungen mit einem kultur- und migrationsspezifischen Workshop für Fachkräfte der Kinder- und Jugend- hilfe in der Arbeit mit misshandelten Kindern und Jugendlichen.

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.

CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany.

BACKGROUND: Most psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care. METHODS: The study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients). Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses. DISCUSSION: Evaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting. TRIAL REGISTRATION: Deutsches Register Klinischer Studien, Trial registration number: DRKS00014838 , registered on 6th of June 2018.

Usual Care for Maltreatment-Related Pediatric Posttraumatic Stress Disorder in Germany.

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.

The connection between teaching and learning: Linking teaching quality and metacognitive strategy use in primary school.

BACKGROUND: In order for teaching to be successful, students need to be actively involved in learning. However, research on teaching effectiveness often neglects students' learning activities. Although it is assumed that effective teaching promotes the use of beneficial learning activities, empirical evidence for this connection is still limited. AIMS: This study aimed to investigate the connection between effective teaching and reported learning activities. We hypothesize specific relations between a three-dimensional model of teaching quality (i.e., cognitive activation, supportive climate, and classroom management) and students' reported use of metacognitive strategies. Students' intrinsic motivation is considered as a mediator and a moderator of this connection. SAMPLE: N = 1,052 students from 53 German primary school classes and their science teachers participated. METHODS: Data were collected through classroom or video observation and questionnaires over a period of approximately 2 months. Multilevel analysis was utilized to test our hypotheses. RESULTS: Each dimension of teaching quality positively predicted students' reported use of metacognitive strategies. For supportive climate, this connection was mediated by students' intrinsic motivation. Cognitive activation negatively predicted the slopes between students' reported metacognitive strategy use and motivation. CONCLUSIONS: The results support the notion that effective teaching is connected to learning activities and stress the importance of students' learning motivation. Results from the cross-level interaction could indicate that especially less motivated students' reported metacognitive strategy use might be supported by cognitively activating teaching.

Physical Activity, Affect, and Cognition in Children With Symptoms of ADHD.

OBJECTIVE: To examine the role of physical activity in determining the affect and executive functioning of children with symptoms of ADHD. METHOD: In Study 1, the association between physical activity and affect in the daily lives of children with varying degrees of hyperactivity was examined. In Study 2, children with ADHD were randomly assigned a physical activity or a sedentary task before working on a task requiring executive control. RESULTS: Lack of physical activity was shown to relate to depressed affect, more strongly in participants with severe hyperactivity symptoms (Study 1). The physically active participants showed improved executive functioning after only 5 min of vigorous activity; the sedentary control participants showed no improvement (Study 2). CONCLUSION: These results indicate that interventions to increase the level of physical activity in children with and without ADHD might improve affect and executive functioning.

[Consumer satisfaction trajectories of adolescents during in-patient psychiatric treatment]. / Behandlungsbewertungen von Jugendlichen im Verlauf einer stationär-psychiatrischen Behandlung.

OBJECTIVE: Patient satisfaction with in-patient treatment and other aspects of process quality is usually examined cross-sectionally (e.g. at discharge). Therefore, the knowledge about changes in patient satisfaction and related issues, such as participation and motivation during the treatment period, is limited. This study describes the development of a questionnaire covering these topics and the course and variability in these domains for different subgroups. METHOD: The study group comprises 88 adolescents (48 females, 40 males; aged 13 to 18 years) who delivered altogether 1,003 data points (median per person is 8). The questionnaire consisted of 16 items that were administered to them by computer twice a week at adolescent wards in two psychiatric departments. Statistical analysis was done using hierarchical linear modeling (growth curve models), which is well suited for the analysis of data with different numbers of assessment points and missing data. RESULTS: Psychometric properties of the questions were good. The trajectories for all items are very heterogeneous with regard to the level.. The trends (slope of the growth curves) are around 0 in general satisfaction, i.e. the adolescents stay on their different levels during the treatment period. Concerning participation, however, there are diverging trends, in particular between the two departments, which may reflect the difference in the treatment experience of the teams, whereas age, gender and diagnosis (internalizing vs. externalizing) play a minor role. CONCLUSION: Evaluation of process characteristics has turned out to be feasible in clinical routine and promising for further insights into process quality.