[Care and law for young people are constantly developing]. / Zorg en recht voor jongeren volop in ontwikkeling.

BACKGROUND: Child and adolescent psychiatry in the Netherlands is part of the broader field of youth care. International treaties, the Youth Act, child protection measures and various legislation for compulsory care provide the framework within which youth care can be provided. AIM: Clarify the laws and regulations of youth care for young people and describe possible changes in the future. METHOD: Study of laws, reports, and commentaries. RESULTS: Laws and regulations governing care for young people are complex and not always effective. The Youth Reform Agenda, the Future Scenario for Child and Family Protection and the Legal Status of Closed Youth Care Act are recent developments that aim to simplify and improve youth care in the Netherlands. CONCLUSION: The legislation and regulations governing healthcare for young people are rapidly developing. Practice will show whether these changes are really improvements.

[For the Benefit of the Children - Judical Requested Counselling of High Conflict Parents in Educational- and Family-Counselling]. / Zum Wohle der Kinder ­ Gerichtlich angeordnete Beratung von Hochkonflikt-Eltern in der Erziehungs- und Familienberatung.

For the Benefit of the Children - Judical Requested Counselling of High Conflict Parents in Educational- and Family-Counselling Educational- and Family Counselling supports families as assistance for parenting for a successful growing up of children. Family Counselling is a voluntary offer, which is provided by a multi professional team. The counselling is confidential and bound to secrecy. According to the regulations of the law concerning the proceedings in family cases and the non-contentious jurisdiction (FamFG) the court has several options for action, such as, for example, to order a counselling in the context of child and youth service. Court related inquiries have led to advancement in Educational- and Family Counselling. In the article basic aspects of specific approaches are described.

[The new German drug market law AMNOG from a child and adolescent psychiatry perspective]. / Das Arzneimittelmarktneuordnungsgesetz aus kinder- und jugendpsychiatrischer Perspektive.

BACKGROUND: The European Union (EU) regulation 1901/2006 plus the implementation of pediatric investigational plans by the European Medicines Agency (EMA) have contributed to more clinical studies in pediatric psychopharmacology. A new drug market law (AMNOG) has been in force in Germany since 2011 that requires an additional process of assessment of benefits of newly authorized medications by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G­BA), which also holds for medications licensed for pediatric populations. OBJECTIVES: Summary of early assessments of benefits for newly registered compounds in the treatment of psychiatric disorders and critical discussion from the perspective of child and adolescent psychiatry. MATERIAL AND METHODS: Application and critical review of documents and written statements by various institutions and stakeholders related to assessment procedures and respective decisions by the G­BA for these medications. RESULTS AND CONCLUSION: Clearly differing requirements for study designs and outcome parameters characterize the conditions for market authorization and for the assessment of benefits. Further adjustments to the regulations in implementing the AMNOG appear to be essential, integrating agencies involved so far, complimented by expertise from regulatory agencies and medical scientific societies.

Epigenetics and Child Psychiatry: Ethical and Legal Issues.

Epigenetics has the potential to revolutionize diagnosis and treatment in psychiatry, especially child psychiatry, as it may offer the opportunity for early detection and prevention, as well as development of new treatments. As with the previous introduction of genetic research in psychiatry, there is also the problem of unrealistic expectations and new legal and ethical problems. This article reviews the potential contributions and problems of epigenetic research in child psychiatry. Previous legal and ethical issues in genetic research serve as a guide to those in epigenetic research. Recommendations for safeguards and guidelines on the use of epigenetics with children and adolescents are outlined based on the identified issues.

[Inclusion - pediatric and adolescent psychiatry aspects]. / Inklusion - kinder- und jugendpsychiatrische Aspekte.

The Convention on the Rights of Persons with Disabilities became legally binding in Germany in March 2009. "Inclusion" is the major concept­all people with any kind of handicap must have the same rights to full and effective participation and inclusion in society. Preceding inclusion come adjustments in society with regard to ethical, legislative, administrative, conceptual, structural, economical, and thus also to healthcare-political frameworks, in order to make disabilities are as far as possible no longer a handicap in an individual's everyday life. This review first outlines the present social status influencing the development of children, a child's welfare, and especially the healthcare of children and adolescents with psychiatric disorders and conditions indicating barriers to inclusion. It focuses on those articles of the UN convention which are relevant with regard to ethical attitude, epidemiology, healthcare framework, diagnostics, therapy, teaching, and research with respect to child and adolescent psychiatry. The analysis points to a significant backlog demand in child psychiatric healthcare, teaching, and research.

[Nonnative guidelines for allocating human resources in child and adolescent psychiatry using average values under convergence conditions instead of price determination - analysis of the data of university hospitals in Germany concerning the costs of calculating day and minute values according to Psych-PV and PEPP-System]. / Normative Vorgaben zum Personaleinsatz in der Kinder- und Jugendpsychiatrie statt Preisfindung anhand von Mittelwerten unter Konvergenzbedingungen.

OBJECTIVE: Despite substantial opposition in the practical field, based on an amendment to the Hospital Financing Act (KHG). the so-called PEPP-System was introduced in child and adolescent psychiatry as a new calculation model. The 2-year moratorium, combined with the rescheduling of the repeal of the psychiatry personnel regulation (Psych-PV) and a convergence phase, provided the German Federal Ministry of Health with additional time to enter a structured dialogue with professional associations. Especially the perspective concerning the regulatory framework is presently unclear. METHOD: In light of this debate, this article provides calculations to illustrate the transformation of the previous personnel regulation into the PEPP-System by means of the data of §21 KHEntgG stemming from the 22 university hospitals of child and adolescent psychiatry and psychotherapy in Germany. In 2013 there was a total of 7,712 cases and 263,694 calculation days. In order to identify a necessary basic reimbursement value th1\t would guarantee a constant quality of patient care, the authors utilize outcomes, cost structures, calculation days, and minute values for individual professional groups according to both systems (Psych-PV and PEPP) based on data from 2013 and the InEK' s analysis of the calculation datasets. CONCLUSIONS: The authors propose a normative agreement on the basic reimbursement value between 270 and 285 EUR. This takes into account the concentration phenomenon and the expansion of services that has occurred since the introduction of the Psych-PV system. Such a normative agreement on structural quality could provide a verifiable framework for the allocation of human resources corresponding to the previous regulations of Psych-PV.

Safe and judicious paediatric psychotropic prescribing.

Psychotropic medications are now a well-established and evidenced based treatment for increasing number of child mental health disorders prescribed at increasing frequencies and by increasing number of professional groups. Clinicians' perceived levels of competence and standardised monitoring lag behind prescribing practice and should be addressed by regular continuous professional development. A study specific questionnaire on psychotropic prescribing practice in children was mailed to all child psychiatrists and paediatricians working in Ireland and GPs from a selected Dublin CAMHS catchment area. Of the 116 who replied, (39% response rate), antidepressants (58.7%), antipsychotics (57.1%) and ADHD medications (36.5%) were most commonly prescribed. Results suggest increasing trends of monitoring amongst Irish clinicians over time, but with some lack of specificity. Commensurate with the wish of clinicians, ongoing training in paediatric psychopharmacology is considered essential in order to benefit from the increasing advances in pharmacology.

Pediatric psychopharmacological research in the post EU regulation 1901/2006 era.

Although the use of psychotropic medications in child and adolescent psychiatry in Germany is on the increase, most compounds are in fact prescribed "off-label" because of a lack of regulatory approval in these age groups. In 2007, the European Parliament introduced Regulation 1901/2006 concerning medicinal products in pediatric populations, with a subsequent amendment in the form of Regulation 1902/2006. The main aim of this legislation was to encourage research and clinical trials in children and adolescents, and thus promote the availability of medications with marketing authorization for these age groups. Furthermore, initiatives such as the European 7th Framework Program of the European Union now offer substantial funding for pediatric pharmacological research. At a recent Congress of the German Society for Child and Adolescent Psychiatry and Psychotherapy (DGKJP), experts from the field and the pharmaceutical industry held a symposium with lay representatives in order to discuss attitudes toward, and experience with, pediatric psychopharmacology research in Germany since 2007. Several areas of concern were identified. The present paper derives from that symposium and provides an overview of these opinions, which remain crucial to the field. A wider discussion of how to facilitate psychopharmacological research in Germany in order to optimize the treatment and welfare of children and adolescents with psychiatric disorders is now warranted.

[Need to merge child and adult psychiatry into comprehensive developmental psychiatry--consideration from the perspective of forensic psychiatry].

The need to merge child and adult psychiatry into a continuum was discussed based on forensic issues in criminal cases involving developmental disorder. Recently, a number of offenders (both juvenile and adult) are being diagnosed with developmental disorder every year, when the system of sending severe juvenile cases from juvenile court to the prosecution as well as the new juror system makes the role of psychiatric examination more important than ever. Because of the unique symptomatology of autism spectrum disorder (ASD), conventional forensic psychiatry does not seem applicable to cases of ASD when making a fair judgement on criminal liability. This indicates that there is a need for not only basic knowledge on child psychiatry for all psychiatrists, but also knowledge on the developmental link between child and adult psychiatry. Therefore, there is a need to merge child and adult psychiatry into a comprehensive field of developmental psychiatry.

Advancing Youth Justice: The Child and Adolescent Psychiatrist's Role.

Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.