Multiple psychosocial risk factors and traumatic life events are common in children and adolescents in youth welfare, especially in residential care. Therefore, children and adolescents in youth welfare institutions are a high-risk population with regard to the development of severe mental disorders. This paper gives an overview of the prevalence of behavioural and emotional symptoms and mental disorders in a German residential care population and compares these findings with prevalence rates in other European countries. It also assesses the shortfall between the mental health needs of this highrisk population and the treatment options available to them. The international prevalence rates findings differ, from 44 to 96%. Most studies with larger samples report a prevalence between 60 and 70%. The most frequent diagnoses among children and adolescents in residential care were severe externalising disorders but a high comorbidity with internalising disorders can be observed. The paper also describes the needs of this population from the perspective of child and adolescent psychiatry and psychotherapy and innovative treatment options in this field. Relevant treatment concepts are outlined, and the paper calls for improved psychiatric liaison services within the child welfare system to provide successful diagnostic and therapeutic services, as well as suggestions to assist social services and professional training and management.
Children, adolescents, mental health needs, residential group homes, youth welfare
Disclosure: The author has no conflicts of interest to declare.
Received: 9 April 2008 Accepted: 26 May 2008
Correspondence: Department of Child and Adolescent Psychiatry, University of Basel, Schaffhauserrheinweg 55, Ch-4058 Basel. E: firstname.lastname@example.org
The number of children and adolescents living in German residential group homes remains relatively constant at around 60,000.1 Multiple isk factors such as poverty, broken homes, neglect, sexual and physical abuse, discontinuous relationships and genetic factors have an impact on the mental health of children and adolescents in residential and foster care,2–4 and 50–80% of children in group homes have had traumatic life experiences.5,6 A German study that obtained information from counsellors on a representative sample of 80 residential care children and adolescents showed that 75% had suffered at least one traumatic life event.7
The upgrading of outpatient social services has indirectly contributed to a worsening of the situation in residential care institutions because only children with the greatest psychosocial burden and severe psychopathological symptoms are given expensive residential care placements. Children and adolescents with adverse family backgrounds are at a very high risk of developing a chronic mental disorder, with subsequent impairment of their psychosocial functioning, for example going on to school failure, unemployment or a criminal career.8,9 In follow-up studies, 19% of children had been placed in three or more different foster families or institutions.7,10 Moving between placements and the repeated breakdown of youth welfare measures may worsen the prognosis because of the detrimental effects of the loss of attachment figures on psychosocial development. Twenty per cent of children and adolescents in Germany leave their residential placement within the first year.11
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