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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