Franka Metzner

Implementing an Inpatient Social Early Warning System for Child Maltreatment

Objectives: The current article describes the process evaluation of a social early warning system (SEWS) for the prevention of child maltreatment in the federal state of Hamburg. This prevention initiative targets expectant mothers and their partners including an initial screening of risk factors for child maltreatment, a subsequent structured clearing interview further exploring risks and identifying protective factors and an optional referral to the regional health and social care system. Method: The process evaluation was conducted by examining the flow of participants through the different stages of the SEWS as well as asking social education workers, parents, and regional institutions about their satisfaction with the process of the SEWS. Results: The participation rate throughout the SEWS as well as the satisfaction rates were high. Conclusions: The SEWS is a secondary prevention initiative with a substantial difference to other early prevention initiatives, as it aims to facilitate intervention rather than providing it.

‘Learning how to ask’: Effectiveness of a training for trauma inquiry and response in substance use disorder healthcare professionals

Context: Exposure to traumatic events should be systematically assessed in health care services so that trauma-related treatment can be offered when appropriate. However, professionals often lack expertise in trauma inquiry and response, and therefore require training in this field. Objective: We aimed to determine whether the “Learning how to ask” training for trauma inquiry and response (Read, Hammersley, & Rudegeair, 2007) is effective in increasing health care professionals’ trauma inquiry behavior. Method: 148 professionals working in outpatient substance use disorder (SUD) services were cluster-randomized into an intervention or a waiting control group. The intervention group received a 1-day training and a refresher session 3 months later, while the control group received no training. The primary outcome was the change from baseline in the frequency of asking clients about traumatic events. Secondary outcomes were professionals’ evaluation of the training, knowledge, attitudes toward and confidence in trauma inquiry and response. Results: Change from baseline in the frequency of asking clients about traumatic events was significantly greater at 3-month and 6-month follow-up in the intervention group compared with the control group (b = 0.43, 95% CI [0.27, 0.59], p < .001). The training was positively evaluated by the participants. Knowledge, positive attitudes toward and confidence in trauma inquiry and response all showed significantly greater increases in the intervention group than in the control group. Conclusions: These findings suggest that health care professionals can acquire skills in trauma inquiry and response from short trainings, which may enhance systematic assessment of traumatic events.

Stellenwert und Umsetzung der Prävention in Deutschland – Eine bundesweite Befragung von Entscheidungsträgern in GKV-Spitzenverband, Bund, Ländern und Kommunen

Representatives of the statutory health insurance (n=46) and policy makers at the local, federal and state level (n=136) were interviewed in 2 nationwide online surveys about the significance and degree of implementation of prevention. The group comparison between the decision-makers shows significant differences in terms of attitudes towards health prevention. The political leaders are demanding an improvement of the GKV-benefit package and the obstacles require the cooperation of urgent attention.

Behavioural and structural prevention to promote the health of socially disadvantaged children and adolescents: an overview of European and German health promotion strategies

IntroductionChildhood and adolescence are significant phases in life,characterized by many physical and psychosocial changes.Diseases and health related attitudes during these sensitivestages of life have a significant and lifelong impact, not onlyon health issues, but also on the overall development (Kuhand Ben-Schlohmo 2005; Power and Kuh 2006). The earlyexperience of health inequalities is a major risk factor forchildren’s and adolescents’ further health development.Thus, the early and efficient prevention of ill-health behav-iours (behavioural prevention) and in relevant social settings(structural prevention) among children and young people,particularly those who are socially disadvantaged, is crucial.Social disadvantage in GermanyDefining social disadvantage is complicated. While somedefinitions emphasize meeting the mental and physical basicneeds (Biermann and Rutzel 1999), others focus on powerand social discrimination (Iben 1997). Most empirical stud-ies, however, define social disadvantage by the socioeco-nomic status.In Germany, life expectancy and quality of life are heavi-ly dependent on income, level of education and occupation(Lampert and Kroll 2010). Differences in income and theproportion of poor people in Germany have increased morerapidly in recent years than in most other ‘Organisation forEconomic Cooperation and Development (OECD)’countries (Organisation for Economic Cooperation andDevelopment 2008). The OECD country comparison(2008) has also shown that social disadvantage and povertyhave become less of a problem for the elderly, but increas-ingly for young people and young families. Gebken (2005)accordingly found that social disadvantage and povertyoccur particularly in young families with several children,with just one parent earning an income, with single parentsand in migrant families.Data from the Socioeconomic Panel (SOEP) in 2008showed that 21% of 13–18-year olds are under particularthreat of poverty. By comparison, the rate for the population

Protective mental health factors in children of parents with alcohol and drug use disorders: A systematic review

Children of parents with drug and alcohol use disorders often grow up under severe stress and are at greater risk of developing psychological and social problems. However, a substantial proportion of affected children adapt to their distressing life conditions and show positive development in terms of their mental health. These children are described as resilient. One difference between resilient and maladapted children is the presence of protective factors. The aim of this systematic review is to provide an overview of the current state of the research concerning protective mental health factors in children of parents with alcohol or drug use disorders (COPAD). For that purpose, the PsychInfo, PubMed, CINAHL and ISI Web of Science databases were searched through January 2017. All the identified publications were screened using previously developed inclusion criteria. The search yielded 3,402 articles. Eleven of these publications (2003–2013) met the criteria for inclusion in the present review. Information on the studies was extracted using an extraction form. A narrative analysis was performed, and the methodological quality was examined using a checklist based on the Mixed Methods Appraisal Tool. The research identified familial, parental, child-related and biological factors that influenced mental health outcomes in affected children (N = 1,376, age range = 1–20 years). Overall, protective mental health factors are understudied in this target group. Most of the included studies were conducted in the United States and employed a cross-sectional design. A comparison of the included cross-sectional and longitudinal studies indicated consistent results related to a secure parent-child attachment. Based on the current state of the research, no causal conclusions with regard to the effectiveness of protective factors can be drawn. To develop effective prevention programs, further longitudinal studies and studies assessing the interactions between risk and protective factors are needed.

Entwicklungstraumastörung (ETS) bei Kindern und Jugendlichen – Ergebnisse einer Patientenpopulation der kinder- und jugend-psychiatrischen Spezialsprechstunde „Gewalt und Trauma“

Objective Children and adolescents who have experienced interpersonal Type-II-trauma often develop symptoms going far beyond the Post-Traumatic Stress Disorder (PTSD). Van der Kolk (2009) suggested the Developmental Trauma Disorder (DTD) to define the extensive symptomatology; however, research on DTD is limited. Method Frequency and group differences of DTD were examined based on physicians’ letters of n = 161 patients between one and 18 years (61 % female) from an out-patient unit for traumatized patients at a paediatric and adolescent psychiatry. Physicians’ letters were rated and analysed using an adapted DTD algorithm. Results In total, 77 % of the patients experienced interpersonal Type-II-trauma, 6 % met the criteria for the adapted DTD diagnosis. DTD criteria were found more frequently in interpersonal Type-II-trauma victims than in patients with accidental or Type-I-trauma, but group differences only reached statistical significance for the DTD criteria B (affective and physiological dysregulation) and G (impairments) at the adjusted 0,2 % significance level. No statistically significant differences for age or gender were found. The posttraumatic symptoms of children younger than seven years were analysed descriptively. Conclusions The results show that, although many children and adolescents have developed symptoms beyond the PTSD, only a small proportion have met the DTD diagnosis. In view of the partially unspecific and contradictory findings, further studies on DTD considering larger samples, the complete DTD criteria, and diagnosis-specific instruments seem to be reasonable and necessary.

Paternal Risk Factors for Child Maltreatment and Father's Participation in a Primary Prevention Program in Germany

ABSTRACT Across the globe, the research into the influence of paternal risk and protective factors on the family, as well as on the involvement of fathers in family-related interventions, is lacking. This study utilized 506 families and examined the characteristics of fathers in psychosocially stressed families and associations between paternal risk factors (PRFs: mental health disorder, physical health disorder, young paternity, unemployment, absence of father) and family risk factors (FRFs: problematic financial situation, problematic housing situation, social isolation) for child maltreatment. The identification of PRFs and FRFs was carried out using information from consultations with social education workers and from a risk inventory completed by the mothers. The data analysis revealed an increased incidence of economic problems found in families with fathers having mental health issues, fathers under the age of 22, and unemployed fathers or single mothers. Other factors such as social isolation occurred more often in families with a single mother. The present study underlines the importance of a fathers involvement for young families. Future research and program recommendations should always systematically include the fathers role in family-related interventions.

Gewaltprävention im Kindes- und Jugendalter im Kurzüberblick@@@Violence prevention in childhood and adolescence – a brief overview

ZusammenfassungAggressive und gewalttätige Verhaltensweisen von Kindern und Jugendlichen können mit bis in das Erwachsenenalter reichenden Auswirkungen auf die körperliche und psychische Gesundheit verbunden sein. Frühzeitig ansetzende Programme zur Gewaltprävention im Kindes- und Jugendalter sollen aggressive Verhaltensweisen verhindern oder verringern, um das Risiko für kurz- und langfristige Entwicklungsbeeinträchtigungen zu reduzieren. Im vorliegenden Beitrag werden in einem Literaturüberblick zunächst Forschungsbefunde zu Prävalenzen, typischen Entwicklungsverläufen und Prädiktoren von Gewaltverhalten im Kindesalter zusammengefasst und den Befunden zu Häufigkeit, Entwicklungsverlauf und Folgen von Jugendgewalt gegenübergestellt. International und deutschlandweit erprobte Programme zur Gewaltprävention für Kinder und Jugendliche werden vor dem Hintergrund verschiedener Settings (Familie, Schule, Community), Zielgruppen (Primär- vs. Sekundärprävention) und Zielvariablen (universell vs. spezifisch) vorgestellt. Empirische Befunde zur Wirksamkeitsprüfung von Gewaltpräventionsprogrammen werden beschrieben und diskutiert. Die dargestellten Befunde verdeutlichen die Relevanz und das Potenzial von Angeboten zur Gewaltprävention für Kinder und Jugendliche, zeigen aber auch die Schwierigkeiten und (Wissens-) Lücken auf.AbstractAggressive and violent behaviour in children and adolescents can be associated with physical and psychological health effects continuing into adulthood. Early programs for violence prevention in childhood and adolescence are intended to prevent or reduce aggressive behaviour in order to decrease the risk for short- and long-term developmental impairments.In a literature review, research findings on prevalence, typical courses of development, and predictors of violent behavior in childhood are first summarized and compared with findings on the frequency, developmental course, and consequences of youth violence. International and German programs for violence prevention in children and adolescents are presented in the context of various settings (family, school, community), target groups (primary vs. secondary prevention) as well as target variables (universal vs. specific). Empirical findings on efficacy testing of violence prevention programs are described and discussed. The presented findings stress the relevance and potential of services for violence prevention for children and adolescents, but also demonstrate the challenges and gaps.Aggressive and violent behaviour in children and adolescents can be associated with physical and psychological health effects continuing into adulthood. Early programs for violence prevention in childhood and adolescence are intended to prevent or reduce aggressive behaviour in order to decrease the risk for short- and long-term developmental impairments. In a literature review, research findings on prevalence, typical courses of development, and predictors of violent behavior in childhood are first summarized and compared with findings on the frequency, developmental course, and consequences of youth violence. International and German programs for violence prevention in children and adolescents are presented in the context of various settings (family, school, community), target groups (primary vs. secondary prevention) as well as target variables (universal vs. specific). Empirical findings on efficacy testing of violence prevention programs are described and discussed. The presented findings stress the relevance and potential of services for violence prevention for children and adolescents, but also demonstrate the challenges and gaps.

Lebenskompetenzförderung wirkt, und wie?!

Zusammenfassung: Lebenskompetenzprogramme zielen darauf ab, gesundheitsrelevante Lebensweisen zu verbessern sowie das Auftreten von körperlichen und psychischen Erkrankungen zu verhindern. Hierfür werden in den Programmen allgemeine Lebenskompetenzen gefördert sowie problemspezifische Fertigkeiten vermittelt. Die Entwicklung und Evaluation von Programmen ist insbesondere für Kinder und Jugendliche vorangekommen, sollte jedoch um weitere Themenfelder für Erwachsene und die Berücksichtigung von Nebenwirkungen ergänzt werden.

[Violence prevention in childhood and adolescence--a brief overview].

ZusammenfassungAggressive und gewalttätige Verhaltensweisen von Kindern und Jugendlichen können mit bis in das Erwachsenenalter reichenden Auswirkungen auf die körperliche und psychische Gesundheit verbunden sein. Frühzeitig ansetzende Programme zur Gewaltprävention im Kindes- und Jugendalter sollen aggressive Verhaltensweisen verhindern oder verringern, um das Risiko für kurz- und langfristige Entwicklungsbeeinträchtigungen zu reduzieren. Im vorliegenden Beitrag werden in einem Literaturüberblick zunächst Forschungsbefunde zu Prävalenzen, typischen Entwicklungsverläufen und Prädiktoren von Gewaltverhalten im Kindesalter zusammengefasst und den Befunden zu Häufigkeit, Entwicklungsverlauf und Folgen von Jugendgewalt gegenübergestellt. International und deutschlandweit erprobte Programme zur Gewaltprävention für Kinder und Jugendliche werden vor dem Hintergrund verschiedener Settings (Familie, Schule, Community), Zielgruppen (Primär- vs. Sekundärprävention) und Zielvariablen (universell vs. spezifisch) vorgestellt. Empirische Befunde zur Wirksamkeitsprüfung von Gewaltpräventionsprogrammen werden beschrieben und diskutiert. Die dargestellten Befunde verdeutlichen die Relevanz und das Potenzial von Angeboten zur Gewaltprävention für Kinder und Jugendliche, zeigen aber auch die Schwierigkeiten und (Wissens-) Lücken auf.AbstractAggressive and violent behaviour in children and adolescents can be associated with physical and psychological health effects continuing into adulthood. Early programs for violence prevention in childhood and adolescence are intended to prevent or reduce aggressive behaviour in order to decrease the risk for short- and long-term developmental impairments.In a literature review, research findings on prevalence, typical courses of development, and predictors of violent behavior in childhood are first summarized and compared with findings on the frequency, developmental course, and consequences of youth violence. International and German programs for violence prevention in children and adolescents are presented in the context of various settings (family, school, community), target groups (primary vs. secondary prevention) as well as target variables (universal vs. specific). Empirical findings on efficacy testing of violence prevention programs are described and discussed. The presented findings stress the relevance and potential of services for violence prevention for children and adolescents, but also demonstrate the challenges and gaps.Aggressive and violent behaviour in children and adolescents can be associated with physical and psychological health effects continuing into adulthood. Early programs for violence prevention in childhood and adolescence are intended to prevent or reduce aggressive behaviour in order to decrease the risk for short- and long-term developmental impairments. In a literature review, research findings on prevalence, typical courses of development, and predictors of violent behavior in childhood are first summarized and compared with findings on the frequency, developmental course, and consequences of youth violence. International and German programs for violence prevention in children and adolescents are presented in the context of various settings (family, school, community), target groups (primary vs. secondary prevention) as well as target variables (universal vs. specific). Empirical findings on efficacy testing of violence prevention programs are described and discussed. The presented findings stress the relevance and potential of services for violence prevention for children and adolescents, but also demonstrate the challenges and gaps.