[The desire and the experience of participation among children and adolescents in inpatient mental healthcare]. / Wunsch und Erleben von Partizipation für Kinder und Jugendliche in der stationären Psychiatrie.

The desire and the experience of participation among children and adolescents in inpatient mental healthcare Abstract. Objective: Children have the right to participate in decisions that affect them. However, the stages and domains of participation relevant within inpatient child and adolescent psychiatry have rarely been empirically investigated. The present study closes this research gap. Method: A prospective, multicenter, questionnaire-based survey was conducted. The questionnaire comprised 100 items, summarized in 16 scales, to assess the desire and the experience of participation. The data were quantitively evaluated. Results: 81 children and adolescents from 5 psychiatric hospitals took part in the study. Overall, they wished more participation than experienced. The higher the level of participation, the greater the difference was between wish and reality. The desire for participation is particularly high for decisions regarding communication with family and friends. The largest difference between desire and experience related to respectful and trusting interaction with patients, and for female patients, this difference was even higher. Conclusion: Participation means more than informed consent. There is still potential for expanding participation in child and adolescent psychiatry, especially at higher levels of participation and concerning decisions about communication with family and friends. A respectful and trusting interaction with patients, regardless of age, sex, or illness, is fundamental.

[Pilot Evaluation of a New Treatment Concept for Children to Improve Emotion Regulation and Stress Resilience. START-Kids: Stress-Arousal-Regulation-Treatment for Kids]. / Pilotevaluation eines neuen Programms zur Förderung von Emotionsregulation und Stressresilienz bei Kindern. START-Kids: Stress-Arousal-Regulation-Treatment for Kids.

Emotional Dysregulation is a frequent challenge in clinical child psychiatric contexts. The Stress-Arousal-Regulation-Treatment for Children aged six to twelve (START-Kids, Dixius u. Möhler, 2021a), was developed as low threshold treatment tool for children with emotional dysregulation. The program is based on principles of dialectic behavioral therapy. The present article focuses feasibility and a first evaluation of this innovative treatment tool for emotionally dysregulated children. 23 child psychiatric patients aged six to twelve years took part in this eight weeks program with two group sessions at 60 min per week. Immediately before and after treatment personality functioning was assessed with the Levels of Personality Functioning Questionnaire LoPF-Q E and OPD-KJ2-SF E. There was no drop-out. Significant positive changes could be found after treatment with regard to therapists' and a trend for parent's ratings. Limitations are small sample size and lack of a treatment-as-usual-control group. START-Kids is an innovative program with high amount of feasibility and a positive influence on aspects of personality functions in children. Future studies, specifically a randomized controlled trial of START-Kids is warranted.

[A complex crisis intervention for a 16-year-old pregnant girl after unaccompanied emigration from Eritrea]. / Komplexe Krisenintervention bei einem 16-jährigen schwangeren Mädchen nach unbegleiteter Flucht aus Eritrea.

Unaccompanied refugee minors are frequently confronted with multiple, potentially traumatizing events; girls tend to show most profound traumatizations. A 16-year-old female refugee minor was admitted to a child psychiatric ward over the weekend for acute suicidal behavior. The girl had fled unaccompanied from Eritrea and was living in a shelter home for adolescents. Pregnancy (23 weeks p. c.) had been diagnosed the previous day, stemming from several rapes that had occurred on her journey through Sudan and Nigeria. The girl had repressed all signs of the pregnancy from her consciousness. However, when it became medically undeniably apparent, she tried to end her life by jumping out of a window. The shelter home staff requested a psychiatric indication for termination of the pregnancy. Implications of medical indications for psychiatric reasons at a pregnancy state of 23 weeks as well as ethical aspects and considerations with regard to posttraumatic symptomatology are discussed in the following case report.

[START - Development of an Intervention for a First Stabilization and Arousal-modulation for Highly Stressed Minor Refugees]. / START ­ Entwicklung einer Intervention zur Erststabilisierung und Arousal-Modulation für stark belastete minderjährige Flüchtlinge.

START - Development of an Intervention for a First Stabilization and Arousal-modulation for Highly Stressed Minor Refugees This article focuses on the development of an intervention called "Stress-Traumasymptoms- Arousal-Regulation-Treatment" (START), through the process of working with refugeed minors in acute stress during the clearing process immediately on arrival in Germany. START is a short manualized structured intervention for crisis intervention and stabiliziation of children and adolescents suffering from intense stress and acute tension or desperation. It consists of five sessions preferred for group or also single treatment. For easy and widespread applicability we translated the START-Manual in Dari, Arab and English. The language is simple and easily understandable and illustrated by picture material. For children incapable of reading there is also an audio version in the different languages. Some compounds of START are derived from elements of dialectic behavioral therapy (Linehan, 2015; Rathus u. Miller, 2015; Bohus u. Wolf, 2011) and traumafocused cognitive behavioral therapy for children (Cohen, Mannarino, Deblinger, 2009). The manual can be used by psychotherapists, social workers, physicians, school psychologists as well as qualified caretakers, given the highly self-instructive character of the instrument. In clinical settings, children of all cultural backgrounds can and should be included in the group treatment. START was very readily accepted by the refugeed children and adolescents and observed to reduce stress in children and supervising professionals. Its efficacy and effectiveness is currently target of a standardized pre-post evaluation. Clinical implications as well as limitations of the concept are discussed.

Effects of a Standardized DBT-A Program on Identity Development in Adolescents.

BACKGROUND: Identity diffusion plays a central role in the onset of borderline personality disorders. Dialectical Behavioral Therapy for Adolescents (DBT-A) is a treatment program for adolescents with emotional instability and dysregulation. The interest of this study is to examine the potential effects of a standardized and certified DBT-A therapy program on the identity development of adolescents in an inpatient setting. METHODS: A total of 138 adolescents aged 13 to 18 years with symptoms of severe emotional instability were assessed before and after a certified and standardized 12-week in-patient DBT-A program targeting emotional regulation with the following standardized instruments: the Assessment of Identity Development in Adolescence (AIDA), Scale of the Experience of Emotions (SEE), and Symptom Checklist (SCL-90-R). RESULTS: The results indicate a significant change in identity development, emotion regulation, and general symptoms of psychopathology after treatment with DBT-A. CONCLUSIONS: In this large sample of adolescents, DBT-A significantly improved identity development and reduced identity diffusion, however, without a treatment-as-usual control group as a limitation. Nevertheless, our results may become clinically relevant for the prevention of chronic impairment in emotionally unstable adolescents.

Feasibility and Effectiveness of a New Short-Term Psychotherapy Concept for Adolescents With Emotional Dysregulation.

Background: The 'Stress-Trauma-Symptoms-Regulation-Treatment' (START) is an innovative manualized short-term treatment program for stabilization and stress resilience in emotionally dysregulated adolescents, based on an approach of stress and management and emotional regulation. The current pilot trial aims to assess the feasibility and effectiveness of the START intervention program for improvement of emotion regulation. Methods: Sixty-six adolescents between the age of 13-18 years admitted to a psychiatric unit for acute emotional or behavioral dysregulation took part in the START program for 5 weeks in an open group setting with two sessions per week (70 min/session). Before treatment, we assessed a history of adverse experience with the Child and Adolescent Trauma Screen (CATS) and the Child Posttraumatic Cognitions Inventory (CPTCI). Before and after treatment, the participants completed the FEEL-KJ, a self-report screening instrument of emotional regulation and coping strategies. Results: A large proportion of this sample had experienced traumatic events based on the CATS (75%) and the CPTCI (82%). The mean FEEL-KJ score significantly decreased after the intervention (d = -0.248, p = 0.037), while no difference was observed with regard to mean level of adaptive emotion regulation strategies (d = 0.202, p = 0.207). A positive effect of the intervention was observed on three components of the adaptive FEEL-KJ scale: accepting (d = 0.289, p = 0.08), forgetting (d = 0.271, p = 0.049) and dealing with anger (d = 0.309, p = 0.034). Conclusion: START demonstrates preliminary evidence for improvement in emotional dysregulation after a 5-weeks course of treatment. Therefore, this short-term intervention can possibly be regarded as a tool to improve emotional stability in children with a high load of trauma-related psychopathology. The results are promising and warrant future studies, specifically randomized controlled trials on the effectiveness of START for strengthening resilience at-risk-populations.