A Creative and Movement-Based Blended Intervention for Children in Outpatient Residential Care: A Mixed-Method, Multi-Center, Single-Arm Feasibility Trial

The COVID-19 pandemic led to psychological distress among children and adolescents. Due to multiple psychosocial burdens, the youth in residential care were especially exposed to an increased risk of mental health problems during the pandemic. In a multi-center, single-arm feasibility trial, N = 45 children and adolescents aged 7–14 years were allocated to a 6-week blended care intervention, conducted in six outpatient residential child welfare facilities. The intervention covered a once weekly face-to-face group session for guided creative (art therapy, drama therapy) and movement-oriented (children’s yoga, nature therapy) activities. This was accompanied by a resilience-oriented mental-health app. Feasibility and acceptance analyses covered app usage data and qualitative data. Effectiveness was determined by pre-post comparisons in quantitative data on psychological symptoms and resources. Further, subgroups for poorer treatment outcome were explored. The intervention and app were considered to be feasible and were accepted by residential staff and the children. No significant pre-post changes were found across quantitative outcomes. However, being female, being in current psychosocial crisis, a migration background, or a mentally ill parent were correlated with change in score of outcomes from baseline. These preliminary findings pave the way for future research on blended care interventions among at-risk children and adolescents

Screening zur frühen Identifizierung des psychosozialen Unterstützungsbedarfs bei Kindern psychisch erkrankter Eltern

Background: Children of mentally ill parents have an increased risk for mental disorders themselves, which is increased once again by the experience of abuse and neglect. Objective: The aim of this study is to present the development and preliminary piloting of a specific screening procedure that enables an early identification of a possible need for support in children with mentally ill parents. Material and methods: For children of mentally ill parents, two screening procedures were developed. In the parent questionnaire of the "children screening" mental abnormalities of the children and adolescents (6-18 years old) as well as resources are collated in an abbreviated form (mental abnormalities: 26 items, available resources: 4 items). In the "family screening" familial risk and stress factors (8 items) are also enquired about in a self-report of the parents as well as indications for abuse and neglect in the family (9 items). Results: Both screening procedures are easy to evaluate with the help of a traffic light system. The responsible psychiatrist receives a preliminary estimation and definite indications on the current need for psychosocial treatment and support of the whole family and particularly the children. Subsequently, they can initiate further steps for the integrated care of the family. Conclusion: The children and family screening procedures are economical in time and easily understandable screening procedures for identification of the need for treatment and support of the family. Subsequently, after the final validation it is planned to systematically implement the screening procedures in the psychiatric care of mentally ill parents. In this way the far-reaching negative consequences for these children can be prevented

Assessment of Psychological Distress and Peer Relations among Trans Adolescents—An Examination of the Use of Gender Norms and Parent–Child Congruence of the YSR-R/CBCL-R among a Treatment-Seeking Sample

Among trans adolescents, increased psychological distress is reported in the literature. The goal of this study was to examine psychological distress, associated peer relations and parent report congruence among the treatment-seeking sample of the Gender Identity Special Consultation (GISC) for youth at the Charite Berlin. Further, differences between the instruments' binary gender norms were investigated. Retrospectively, we analyzed clinical data derived from the GISC. By initial interviews and using the Youth Self-Report and Child Behavior Checklist, n = 50 trans adolescents aged 12-18 years (M = 15.5) were examined for psychological problems and peer relations. Congruence between self and parent report was analyzed by correlations. Half of the sample reported suicidality, self-harm and bullying. Trans adolescents showed significantly higher internalizing and total problems than the German norm population. The congruence between self and parent report proved to be moderate to high. The level of congruence and poor peer relations were identified as predictors of internalizing problems. Significant differences between the female vs. male gender norms emerged regarding mean scores and the number of clinically significant cases. Data provide valuable implications for intervention on a peer and family level. There are limitations to the suitability of questionnaires that use binary gender norms, and further research on adequate instruments and assessment is needed

Almost 2 years into the COVID-19 pandemic: an update on parental stress, parent mental health, and the occurrence of child maltreatment

Increased parental stress, poorer mental health, and an increase in the occurrence of child maltreatment (CM) have been reported in earlier phases of the COVID-19 pandemic. However, data from later phases of the pandemic are not yet available. We conducted a cross-sectional, representative survey among 1087 parents (48.8% female; mean age 41.72 years, SD = 9.15) in Germany in December 2021. Data were compared to a previous representative sample, assessed in August 2020 (N = 1024), and to normative scores of the outcome measures. Predictors for the occurrence of CM were analyzed by logistic regression. Pandemic-related stress and general stress were higher and physical and mental health were poorer in the December 2021 sample than in the August 2020 sample. Occurrence rates of CM varied between 5 and 56%. Verbal emotional abuse (n = 607, 56%), witnessing domestic violence (n = 446, 41%), and emotional neglect (n = 435, 40%) were most frequently reported. For these subtypes, parental risk for alcohol abuse (OR 2.1–2.7) and parental recent experience of violence (OR 2.1–5.1) were the strongest predictors. Across all subtypes of CM, parents reporting child maltreatment showed poorer scores on all stress outcomes, with medium–large-effect sizes. Results confirm a high burden within the families, almost 2 years into the pandemic. Occurrence rates of a broad spectrum of CM subtypes raise further concerns for the well-being of children. Family-oriented intervention efforts are needed to stabilize families and provide targeted support. Longitudinal studies are needed for a description of families at risk for poorer outcomes

End-User Development for Artificial Intelligence: A Systematic Literature Review

In recent years, Artificial Intelligence has become more and more relevant in our society. Creating AI systems is almost always the prerogative of IT and AI experts. However, users may need to create intelligent solutions tailored to their specific needs. In this way, AI systems can be enhanced if new approaches are devised to allow non-technical users to be directly involved in the definition and personalization of AI technologies. End-User Development (EUD) can provide a solution to these problems, allowing people to create, customize, or adapt AI-based systems to their own needs. This paper presents a systematic literature review that aims to shed the light on the current landscape of EUD for AI systems, i.e., how users, even without skills in AI and/or programming, can customize the AI behavior to their needs. This study also discusses the current challenges of EUD for AI, the potential benefits, and the future implications of integrating EUD into the overall AI development process.Comment: This version did not undergo peer-review. A corrected version is published by Springer Nature in the Proceedings of 9th International Syposium on End-User Development (ISEUD 2023). DOI: https://doi.org/10.1007/978-3-031-34433-6_

study protocol for a randomized-controlled trial

Background Functional abdominal pain (FAP) is not only a highly prevalent disease but also poses a considerable burden on children and their families. Untreated, FAP is highly persistent until adulthood, also leading to an increased risk of psychiatric disorders. Intervention studies underscore the efficacy of cognitive behavioral treatment approaches but are limited in terms of sample size, long-term follow-up data, controls and inclusion of psychosocial outcome data. Methods/Design In a multicenter randomized controlled trial, 112 children aged 7 to 12 years who fulfill the Rome III criteria for FAP will be allocated to an established cognitive behavioral training program for children with FAP (n = 56) or to an active control group (focusing on age-appropriate information delivery; n = 56). Randomization occurs centrally, blockwise and is stratified by center. This study is performed in five pediatric gastroenterology outpatient departments. Observer- blind assessments of outcome variables take place four times: pre-, post-, 3- and 12-months post-treatment. Primary outcome is the course of pain intensity and frequency. Secondary endpoints are health-related quality of life, pain- related coping and cognitions, as well as selfefficacy. Discussion This confirmatory randomized controlled clinical trial evaluates the efficacy of a cognitive behavioral intervention for children with FAP. By applying an active control group, time and attention processes can be controlled, and long-term follow-up data over the course of one year can be explored

Evaluation of an Early Intervention Model for Child and Adolescent Victims of Interpersonal Violence

Only the minority of youth exposed to traumatic events receive mental health care, as trauma-informed clinical services are lacking or are poorly accessible. In order to bridge this gap, the Outpatient Trauma Clinic (OTC) was founded, an easily accessible early, short-time intervention, with onward referral to follow-up treatment. This report presents the OTC’s interventional approach and first outcome data. Using a retrospective naturalistic design, we analyzed trauma- and intervention-related data of the sample (n = 377, 55.4% female, mean age 10.95, SD = 4.69). Following drop-out analyses, predictors for treatment outcome were identified by logistic regression. The majority (81.9%) was suffering from posttraumatic stress disorder (PTSD) or adjustment disorders. Around one forth dropped out of treatment; these cases showed higher avoidance symptoms at presentation. In 91%, psychological symptoms improved. Experience of multiple traumatic events was the strongest predictor for poor treatment outcome (B = −0.823, SE = 0.313, OR = 0.439, 95% CI 0.238–0.811). Around two thirds were connected to follow-up treatment. The OTC realized a high retention rate, initial improvement of symptoms and referral to subsequent longer-term psychotherapeutic treatment in the majority. Further dissemination of comparable early intervention models is needed, in order to improve mental health care for this vulnerable group

Belastungen, positive Veränderungen und Ressourcen von Familien in der COVID-19-Pandemie

Theoretischer Hintergrund: Die Maßnahmen zur Eindämmung der COVID-19-Pandemie stellten Familien vor Herausforderungen. Es fehlt an Studien, welche die umfassende Vielfalt der subjektiven Erfahrungen abbilden. Fragestellung: Ziel ist, Belastungen, positive Veränderungen und Ressourcen in Familien zu erfassen. Methode: 4 967 Eltern (87.6 % weiblich, 86.7 % mit Hochschulreife) minderjähriger Kinder (0 – 17 Jahre) nahmen an einer Online-Erhebung im August 2020 teil. Belastungen, positive Veränderungen und Ressourcen während der Pandemie wurden durch offene Fragen erfasst. Auf Basis der Freitextantworten wurde ein Kategoriensystem entwickelt und ausgewertet. Ergebnisse: Die Vereinbarkeit von Beruf und Privatleben (12 %), Sorgen um die Entwicklung der Pandemie (11 %) und eingeschränkte Betreuung und schulische Bildung (9 %) wurden am häufigsten als Belastungen genannt. Positive Veränderungen waren vermehrte Wertschätzung, Dankbarkeit und neue Einstellungen (16 %), engere Beziehungen innerhalb der Familie (13 %) und mehr Zeit mit Menschen (11 %). Wichtige Ressourcen für Familien waren das soziale Miteinander innerhalb der Familie (19 %) und positive Aktivitäten (13 %). Diskussion und Schlussfolgerung: Ansatzpunkte für familienzentrierte Präventionsmaßnahmen sind die Offenhaltung von Betreuungseinrichtungen, eine Flexibilisierung der Arbeitssituation, eine fortlaufende Aufklärung über notwendige Maßnahmen, Stärkung digitaler Unterstützungsangebote einschließlich der Verbesserung der Medienkompetenz, die Ermöglichung von Freizeitaktivitäten, sowie die Verbesserung psychosozialer Unterstützungsmaßnahmen.Theoretical Background: The COVID-19 pandemic and the resulting consequences led to new family challenges (e. g., school and daycare closings, home office). Studies examining the variety of experiences are scarce. Objective: We examined (1) what burdened families the most during the pandemic, (2) whether there were positive changes in families, and (3) what resources helped parents to manage the crisis. Method: We conducted an online survey in August 2020 in Germany with N = 4 967 parents (87.6 % female, 86.7 % higher school education) with minor children (0 – 17 years). We analysed their answers to three open-ended-questions: (1) “Overall, what caused you the most stress during the pandemic?” (2) “What has changed for the better during the pandemic?” (3) “What helped you the most during the pandemic?”. We used an inductive approach and developed a category system based on the answers. We analysed the frequencies of developed categories using MAXQDA (VERBI Software, 2019). Results: Parents were stressed most by the difficult compatibility of job and family life (12.0 %), worries about the progression of the pandemic (11.1 %), and the closure of care facilities and education institutions (8.5 %). On the other hand, parents also reported positive changes that emerged from the pandemic: more gratitude and new attitudes (16.1 %); closer relationships within the family (13.0 %); and more time to spend with others (10.6 %). Family resources were: social interaction within the family (19.1 %), outside family life (10.9 %), and increased positive activities (13.3 %). Discussion and Conclusion: Our results provide insight into the individual experiences of families during the COVID-19 pandemic in Germany. Based on the results, needs- and family-based interventions can be derived that focus on reducing the burden, on maintaining the positive changes on a long-term basis, and on strengthening family resources. Examples are opening child-care facilities, establishing flexible work arrangements, allowing social contact in social bubbles, providing information on actions, strengthening media competence, providing positive activities, training awareness for positive changes and resources, and disseminating support measures

Do Mothers Benefit from a Child-Focused Cognitive Behavioral Treatment (CBT) for Childhood Functional Abdominal Pain? A Randomized Controlled Pilot Trial

While the efficacy of cognitive-behavioral treatment (CBT) approaches for childhood functional abdominal pain (FAP) is well-established for child outcomes, only a few studies have reported on parent-specific outcomes. This randomized controlled pilot trial analyzed effects of a group CBT on maternal variables (i.e., pain-related behavior, worries and self-efficacy, as well as general psychosocial strain). Methods: The sample constituted of 15 mothers in the intervention group (IG) and 14 mothers in the waitlist control group (WLC). Outcome measures were assessed pre-treatment, post-treatment and at three months follow-up. Results: Analyses revealed significant, large changes in maladaptive maternal reactions related to the child’s abdominal pain in the IG compared to the WLC—i.e., reduced attention (d = 0.95), medical help-seeking (d = 0.92), worries (d = 1.03), as well as a significant increase in behaviors that encourage the child’s self-management (d = 1.03). In addition, maternal self-efficacy in dealing with a child’s pain significantly increased in the IG as well (d = 0.92). Treatment effects emerged post-treatment and could be maintained until three months follow-up. There were no effects on general self-efficacy and maternal quality of life. Conclusion: While these results are promising, and underline the efficacy of the CBT approach for both the child and mothers, further studies, including long-term follow-ups, are warranted