Framework and effects of the life story work based group intervention ANKOMMEN for adolescents in residential care in Germany. A qualitative analysis of interviews with participants

Adolescents in out-of-home care are a high-risk population due to their accumulation of adverse childhood experiences. Furthermore, out-of-home placement itself is a critical life event. Life story work (LSW) is a method for coping with critical life events. However, the need for a high amount of resources makes its implementation in care settings difficult. To improve the accessibility of LSW in residential care, the ANKOMMEN (English “Arriving”) intervention was developed as a manualized and cost-efficient group intervention. This study aims to explore the experiences of adolescents who took part in the intervention in order to examine how participation benefited them and what contributed to these beneficial effects. For this reason, we analyzed n = 48 individual interviews with adolescents after completing the intervention. The focused interview analysis method was used to transcribe and code the interviews. The qualitative analyses revealed that the framework of the intervention helped the participants to open up and to process parts of their history within the group. Moreover, the group setting was a major contributory factor to the positive effects of the intervention by encouraging the participants to exchange their experiences, through mutual peer support and the normalization of adverse thoughts and feelings. Furthermore, participation in the intervention increased self-esteem and self-efficacy in some participants. It contributed to the improvement of positive relationships, helped clarify placement associated events, thoughts and feelings, and improved the acceptance of the placement. Further research is needed to validate these findings and thus widen the range of application of LSW

Evaluation of two family-based intervention programs for children affected by rare disease and their families – research network (CARE-FAM-NET): study protocol for a rater-blinded, randomized, controlled, multicenter trial in a 2x2 factorial design

Background: Families of children with rare diseases (i.e., not more than 5 out of 10,000 people are affected) are often highly burdened with fears, insecurities and concerns regarding the affected child and its siblings. Although families caring for children with rare diseases are known to be at risk for mental disorders, the evaluation of special programs under high methodological standards has not been conducted so far. Moreover, the implementation of interventions for this group into regular care has not yet been accomplished in Germany. The efficacy and cost-effectiveness of a family-based intervention will be assessed. Methods/design: The study is a 2x2 factorial randomized controlled multicenter trial conducted at 17 study centers throughout Germany. Participants are families with children and adolescents affected by a rare disease aged 0 to 21 years. Families in the face-to-face intervention CARE-FAM, online intervention WEP-CARE or the combination of both will be treated over a period of roughly 6 months. Topics discussed in the interventions include coping, family relations, and social support. Families in the control condition will receive treatment as usual. The primary efficacy outcome is parental mental health, measured by the Structured Clinical Interview for DSM-IV (SCID-I) by blinded external raters. Further outcomes will be assessed from the parents’ as well as the children’s perspective. Participants are investigated at baseline, 6, 12 and 18 months after randomization. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed. Discussion: This paper describes the implementation and evaluation of two family-based intervention programs for Children Affected by Rare Disease and their Family’s Network (CARE-FAM-NET) in German standard care. A methodologically challenging study design is used to reflect the complexity of the actual medical care situation. This trial could be an important contribution to the improvement of care for this highly burdened group. Trial registration: German Clinical Trials Register: DRKS00015859 (registered 18 December 2018) and ClinicalTrials.gov: NCT04339465 (registered 8 April 2020). Protocol Version: 15 August 2020 (Version 6.1). Trial status: Recruitment started on 1 January 2019 and will be completed on 31 March 2021. © 2020, The Author(s)

Sexueller Missbrauch: Partizipative Modelle der gesellschaftlichen Aufarbeitung und Innovationen in der therapeutischen Versorgung Betroffener

Nachdem im Winter 2010 vielzählige Missbrauchsfälle in kirchlichen und pädagogischen Institutionen bekannt wurden, rückte das Thema des sexuellen Missbrauchs erstmalig in die Aufmerksamkeit der breiten Öffentlichkeit. Die Politik reagierte mit der Einrichtung des Runden Tisches sowie der Einsetzung der Unabhängigen Beauftragten mit dem Ziel der Aufarbeitung der vergangenen Fälle, der Verbesserung der Situation Betroffener sowie der Ausweitung und Optimierung von Präventionsmaßnahmen. Zu diesem Zweck sollten von den beiden Stellen Empfehlungen an die Politik formuliert werden. Um den politischen Aufarbeitungsprozess zu großen Teilen auf die Basis der Beteiligung Betroffener zu stellen, richtete die Unabhängige Beauftragte eine Anlaufstelle für Betroffene sowie deren Angehörige und Umfeld ein, wohin sich mit politischen Botschaften, Wünschen und Erfahrungen bezüglich sexuellen Missbrauchs gewandt werden konnte. Die vorliegende Arbeit beschäftigt sich schwerpunktmäßig mit der Begleitforschung zu dieser Anlaufstelle. Es wurde untersucht, ob die groß angelegte Beteiligung Betroffener am politischen und gesellschaftlichen Aufarbeitungsprozess im Rahmen eines als Critical Incident Reporting System angelegten Beschwerdemanagementsystems gelungen ist, und welche fachlichen, politischen sowie gesellschaftlichen Auswirkungen sich daraus ergeben haben. Zusammenfassend konnte gezeigt werden, dass die Beteiligung Betroffener am Aufarbeitungsprozess machbar und sinnvoll war. Es wurden knapp 5.000 Betroffene erreicht und hierdurch, mit Hilfe eines webbasierten Erhebungsrasters, eine bis dato einzigartige Datensammlung zu sexuellem Missbrauch erstellt. Die Erkenntnisse aus diesen Daten erweiterten das Wissen über sexuellen Missbrauch und lieferten die Grundlage für die Empfehlungen der Unabhängigen Beauftragten an die Politik – und somit auch für konkrete politische Veränderungen, wie beispielsweise die Einführung eines Bundeskinderschutzgesetzes im Jahr 2012. In einem Folgeprojekt, das sich direkt aus der Empfehlung der Unabhängigen Beauftragten, Betroffenen schnell und unbürokratisch traumaspezifische therapeutische Angebote zur Verfügung zu stellen, ergab, konnte gezeigt werden, dass diese traumatherapeutischen Frühinterventionen einen deutlich reduzierenden Effekt auf die posttraumatische Stresssymptomatik hatten

The Predictors of Awareness of Sexual Abuse and Sexual Violence in the Media and the Influence on Actions of the Individuals

Introduction: The number of reportings on sexual abuse (SA), sexual violence (SV) cases covered in the media has risen a significant amount with most cases involving women and children. The aim of the study is to explore the questions: Are people aware of sexual abuse and sexual violence in the media? What are the predictors of awareness of sexual abuse and sexual violence? Does the awareness of sexual abuse and sexual violence in the media affect the actions of the individuals? Methods: A representative survey of the German-speaking resident population (2020) on physical and mental well-being was used. The participants (N = 2,503: females = 50.9%) were between the ages of 14 and 97 (M = 49.81). The German version of the Adverse Childhood Experiences Questionnaire, The General Habitual Well-Being Questionnaire and questions about own experiences of sexual harassment on the internet, experiences of domestic sexual abuse and different socio-economic variables were used. The outcome variables regarding the awareness of SA and SV in the media, different types of scandals (church, pedophile, USA), #MeToo-debate and the change in actions were used. Frequency analyses and binary regressions were conducted. Results: One thousand five hundred and fifty-five (62.6%) respondents answered yes to being aware of SA and SV in the media. The results show that females, aging, number of children in household, Protestant and Catholic religion, school graduation, own experience(s) of sexual harassment on the internet, own experience(s) of SA in childhood, and Adverse Childhood Experiences have a significant higher association to the awareness of SA and SV in the media. German nationality and Muslim religion have a significant lower association. The variables that most commonly affected the awareness of SA and SV, scandals, debate and the individual actions were age, own experiences of sexual harassment on the internet and the Protestant religion. Conclusion: Advertising more support centers, hotlines and linking this information to sexual abuse cases covered in the media should be considered. Media bystander interventions could be helpful to train people to react appropriately. Further investigation that considers the different types of media and its influence on the awareness of SA and SV is needed

The immediate impact of lockdown measures on mental health and couples’ relationships during the COVID-19 pandemic: Results of a representative population survey in Germany

Background Lockdown measures during the COVID-19 pandemic are expected to have negative effects on mental health and relationship quality. However, little is known about the magnitude of these psychological effects on a population level and for vulnerable subgroups. Methods A representative sample (N = 2503; 50.2% female; mean age = 49.5) of the German population was assessed face-to-face during the COVID-19 pandemic (February 10-April 25, 2020). They were examined for differences in mental health (BSI-18) and relationship quality (PFB) in a pre-lockdown and lockdown subsamples. After testing and establishing the measurement models in confirmatory factor analyses, we added covariates as predictors of the factors to the regression model to investigate the impact of the lockdown measures. Results Overall, participants included after the introduction of lockdown measures reported significantly fewer mental health problems than participants included before the lockdown. Predictor analyses revealed that this effect was larger for participants of younger age and those with higher household income. There was no significant difference in relationship quality between pre-lockdown and lockdown. However, relationship quality improved for younger participants after the lockdown measures started, but deteriorated for older participants. Conclusions The German population was found to be largely resilient to the immediate effects of lockdown on mental health and relationship quality. Older participants and those with lower socio-economic status might constitute risk groups during times of lockdown. Further studies in countries affected by more drastic lockdown measures and the long-term consequences of the pandemic are needed to inform decision makers about the psychological effects of lockdown

The immediate impact of lockdown measures on mental health and couples’ relationships during the COVID-19 pandemic:Results of a representative population survey in Germany

BACKGROUND: Lockdown measures during the COVID-19 pandemic are expected to have negative effects on mental health and relationship quality. However, little is known about the magnitude of these psychological effects on a population level and for vulnerable subgroups. METHODS: A representative sample (N = 2503; 50.2% female; mean age = 49.5) of the German population was assessed face-to-face during the COVID-19 pandemic (February 10-April 25, 2020). They were examined for differences in mental health (BSI-18) and relationship quality (PFB) in a pre-lockdown and lockdown subsamples. After testing and establishing the measurement models in confirmatory factor analyses, we added covariates as predictors of the factors to the regression model to investigate the impact of the lockdown measures. RESULTS: Overall, participants included after the introduction of lockdown measures reported significantly fewer mental health problems than participants included before the lockdown. Predictor analyses revealed that this effect was larger for participants of younger age and those with higher household income. There was no significant difference in relationship quality between pre-lockdown and lockdown. However, relationship quality improved for younger participants after the lockdown measures started, but deteriorated for older participants. CONCLUSIONS: The German population was found to be largely resilient to the immediate effects of lockdown on mental health and relationship quality. Older participants and those with lower socio-economic status might constitute risk groups during times of lockdown. Further studies in countries affected by more drastic lockdown measures and the long-term consequences of the pandemic are needed to inform decision makers about the psychological effects of lockdown

A web-based psychological support program for caregivers of children with rare chronic diseases: a randomized controlled trial

Abstract Background Approximately 50% of rare diseases have symptom onset during childhood. A high level of nursing care and an often uncertain prognosis put caregivers of the affected children at high risk for psychological distress. At the same time, their caregivers have limited access to appropriate psychological care. The aim of this study was to evaluate a web-based psychological support program for caregivers of children with chronic rare diseases (WEP-CARE). Methods German-speaking parents (recruited between May 2016 and March 2018) caring for children aged 0–25 years with a rare disease showing clinically relevant anxiety symptoms, were assigned to either the WEP-CARE (n = 38) or treatment as usual (n = 36) condition within a randomized controlled trial. The primary outcome measure was parental anxiety, assessed with the Generalized Anxiety Disorder Questionnaire (GAD-7). Secondary outcomes were fear of disease progression, depression, coping, quality of life and user satisfaction. The group differences were tested through repeated-measures analyses of variance. The WEP-CARE group was additionally followed up three months after the treatment. Results A significant time-group interaction was found for anxiety (F (1,35) = 6.13, p = .016), fear of disease progression (F (1,331) = 18.23, p < .001), depression (F (1,74) = 10.79, p = .002) and coping (F (1,233) = 7.02, p = .010), suggesting superiority of the WEP-CARE group. Sustainability of the treatment gains regarding anxiety, fear of disease progression and coping was confirmed at the 6-month follow-up assessment (p < .01). A significant interaction effect could not be found for quality of life (F(1,2) = 0.016; p = .899). Both participating parents and therapists were satisfied with WEP-CARE. Conclusions Our results underline the efficacy and feasibility of WEP-CARE for parents of children with various rare diseases