Hilfebedarf und Hilfsangebote in der Versorgung von unbegleiteten minderjährigen Flüchtlingen

Discriminatory, racist and xenophobic policies and practice against child refugees, asylum seekers and undocumented migrants in European health systems

Child refugees, asylum seekers and undocumented migrants who have been forcibly displaced from their countries of origin have heightened health needs as a consequence of their migration experiences. Host countries have a duty to respond to these needs, yet across Europe we are seeing a rise in potentially harmful discriminative, hostile and restrictive migration policies and practices. Research exploring the role racism, xenophobia and discrimination in European health systems may play in child migrant health inequities is lacking. This Personal View seeks to highlight this knowledge gap and stimulate discourse on how discrimination in health information systems, data sharing practices, national health policy, healthcare entitlements, service access, quality of care, and healthcare workers attitudes and behaviours may infringe upon the rights of, and impact the health of child refugees, asylum-seekers and undocumented migrants. It calls for action to prevent and mitigate against potentially harmful policies and practices.

Trauma-sensitive school concepts for students with a refugee background: a review of international studies

Children and adolescents with a refugee background are at high risk for traumatization. Once they arrive in safe countries, schools are the institutions where teachers are responsible for caring for them sensitively and competently. Furthermore, schools are organized in learning groups consisting of multiple peers of the same age, which provides excellent opportunities for social learning and experiences of social support. In this respect, schools are the appropriate places where preventive concepts can be applied to students with a refugee background. This systematic review summarizes studies that examine or evaluate existing international concepts of trauma-sensitive schools for supporting traumatized students with a refugee background. Based on N = 41 selected articles, 17 relevant concepts of trauma-sensitive schools were identified. In 35.3% of the concepts, traumatized students with a refugee background are explicitly included in the target group of the concept, while 47.1% of the concepts refer to groups of students with trauma as a result of various adverse childhood experiences, which also occur more frequently within the population of refugee children and adolescents 17.6% of the concepts contain specific adaptations for pupils with a refugee background. The majority of these concepts were developed in the United States. Additional concepts can be reported for Australia, the United Kingdom, Turkey, and Cambodia. Based on available empirical data, no significant effectiveness regarding the researched concepts' effects on academic and other school-related data can be determined. Although some studies indicate positive effects concerning school-related target variables, most of the studies have only limited significance due to inadequate research designs and methodological deficiencies. Therefore, there is a great need for further development, careful implementation, and evaluation of trauma-sensitive concepts in schools, especially for the growing group of refugee students.

Mental health problems in unaccompanied young refugees and the impact of post-flight factors on PTSS, depression and anxiety-A secondary analysis of the Better Care study

Background

Unaccompanied young refugees (UYRs) show elevated levels of mental distress such as post-traumatic stress symptoms (PTSS), depression, and anxiety. The individual post-arrival situation in the host country plays an important role in increasing or reducing mental health risks for these vulnerable children and youth. The study aims at examining the impact of pre- and post-migration factors on the mental health of UYRs.

Methods

A cross-sectional survey of N = 131 young refugees (81.7% male, M = 16.9 years old) was conducted in 22 children and youth welfare service (CYWS) facilities in Germany. The participants provided information about pre- and post-flight experiences. Standardized measures were used to assess post-traumatic stress symptoms (CATS-2), symptoms of depression (PHQ-9), and anxiety (GAD-7). Daily stressors were assessed with the Daily Stressors Scale for Young Refugees (DSSYR), sociocultural adaptation with the Brief Sociocultural Adaptation Scale (BSAS), satisfaction with social support with the Social Support Questionnaire (SSQ6-G).

Results

Our results demonstrated clinical levels of PTSS in 42.0% of the participants, depression in 29.0%, and anxiety in 21.4%. Hierarchical regression analyses revealed that a higher number of traumatic events and social daily stressors predicted higher levels in all three domains of mental health problems. PTSS and anxiety were also predicted by the distress related to the residence status, depressive symptoms were additionally predicted by sociocultural adaptation, less family contact and length of stay. The satisfaction with social support was not a significant predictor in the regression models.

Conclusion

Unaccompanied young refugees in CYWS facilities are a highly vulnerable population. As traumatic events, daily stressors and level of contact to family directly impacted UYRs mental health, interventions should be trauma-focused, but also contain modules on how to cope with daily stressors. On the policy and practical level, stakeholders in host countries are called for establishing measures to reduce post-migration stressors and enhance support for UYRs on all levels.

[The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany]

The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany Abstract. Abstracts: Objective: This articles investigates the psychological distress and stressful life events in unaccompanied minor refugees (UMR) in adolescence and accompanied minor refugees (AMR) in childhood and adolescence living in Germany. Additionally, it analyzes the predictors of psychological distress in the adolescents. Method: We assessed 170 children and adolescents (adolescents: n = 56 UMR, n = 72 AMR; children: n = 42 AMR) using questionnaires on emotional and behavioral problems and stressful life events. In addition, we questioned the adolescents on PTSS (adolescents: self-report; children: caregiver report). Results: 45.8 % UMR (adolescents), 42.4 % AMR (adolescents), and 56.1 % AMR (children) showed emotional and behavioral problems. On average, we identified 7 stressful life events in UMR (adolescents) and 4 in AMR (adolescents, children). UMR (adolescents) reported more emotional problems, more PTSS, and more stressful life events than did AMR (adolescents). 43.8 % UMR (adolescents) and 27.9 % AMR (adolescents) reported PTSS. The number of stressful life events was found to be the most robust predictor for emotional and behavioral problems as well as PTSS in adolescents. Conclusions: The results indicate the need for psychological interventions of refugee minors in Germany.

Health-related quality of life in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden: a nation-wide, cross-sectional study

PURPOSE

To examine health-related quality of life (HRQoL) in refugee minors resettled in Sweden and compare results to a European reference population, while exploring associations between sociodemographic factors and HRQoL dimensions.

METHODS

A cross-sectional, nation-wide study was conducted with a stratified sample of refugee minors ages 12-15 and 16-18 from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018. HRQoL was measured using KIDSCREEN-27. HRQoL dimension scores of the sample were compared to mean scores of European age and gender-matched reference population. Associations between sociodemographic factors and HRQoL dimensions were investigated with independent t tests and ANOVA. A multivariable regression analysis was performed to identify the sociodemographic factors associated with HRQoL.

RESULTS

The questionnaire was sent to 10,000 potential respondents. The response rate was 26%, yielding n = 2559 refugee minors (boys 55%, girls 45%) in the study sample. Compared to European references, minors in the present study had significantly lower scores of HRQoL within psychological wellbeing and peers and social support, whereas levels for autonomy and parent/guardian relations and school environment were higher. Several sociodemographic factors were significantly associated with all HRQoL dimensions, with those 16-18 years old, having average or poor family economy, and living with an unrelated adult or family reporting lower levels of HRQoL. Minors from Afghanistan had significantly lower scores of HRQoL for all dimensions compared to those from Iraq and Syria.

CONCLUSION

Refugee minors had significantly lower levels of HRQoL for psychological wellbeing and peers and social support compared to European references. Future research should further investigate this potential HRQoL gap further.

A systematic review of risk and protective factors of mental health in unaccompanied minor refugees

In recent years, there has been a rising interest in the mental health of unaccompanied minor refugees (UMR), who are a high-risk group for mental disorders. Especially the investigation of predictive factors of the mental health of young refugees has received increasing attention. However, there has been no review on this current issue for the specific group of UMR so far. We aimed to summarize and evaluate the existing findings of specific risk and protective factors to identify the most verified influences on the mental health of UMR. Therefore, we conducted a systematic literature search. Study designs were limited to quantitative cross-sectional and longitudinal designs. Eight databases were searched in four different languages and article reference lists of relevant papers were screened. 27 studies were included (N = 4753). Qualitative synthesis revealed the number of stressful life events to be the most evaluated and verified risk factor for mental health of UMR. A stable environment and social support, on the other hand, can protect UMR from developing poor mental health. Besides that, several other influencing factors could be pointed out, such as type of accommodation, family contact, gender and cultural competences. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. This review helps to improve our understanding of determinants of UMRs mental health and thus to provide more targeted treatment. Furthermore, it provides information on how to prevent the development of mental health problems by specifying factors that can be modified by different health and immigration sectors in advance. Further research is needed focusing on the interaction between the various predictive factors.

Prevalences of mental distress and its associated factors in unaccompanied refugee minors in Germany

Prevalences for mental disorders within minor refugees are comparatively high and heterogeneous. To reduce heterogeneity and identify high-risk subgroups, we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress. Furthermore, we examined associative factors of mental distress in URM on a broad scale. We conducted a survey with a cross-sectional design in four German University hospitals. The sample consisted of n = 172 URM and n = 52 ARM aged 14-21. Depressive symptoms were assessed via the Patient Health Questionnaire (PHQ-9). Mental distress was assessed by the Refugee Health Screener (RHS-15). Mann-Whitney test was used to examine differences between URM and ARM. Associated factors of mental distress were evaluated via a stepwise multiple regression analysis. URM showed significantly higher mean scores for PHQ-9 (p < .001) and RHS-15 (p < .001) compared to ARM indicating medium effect sizes. Furthermore, URM were significantly more likely to surpass the cut-off for depression (61.6% vs. 30.8%) and overall mental distress (81.4% vs. 53.8%) compared to ARM. The factors Number of stressful life events (SLE), Female gender, and Fear of deportation were found to be associated with an increased mental distress in URM, whereas Weekly contact to a family member, School attendance, and German language skills were accompanied with lower distress scores. All six factors accounted for 32% of the variance of mental distress in URM (p < .001). Within minor refugees, URM are a highly vulnerable subgroup, which should receive particular attention and more targeted measures by health authorities. Our results indicate that these measures should comprise a rapid promotion of family contact, school attendance, language acquisition, and the fast processing of asylum applications. However, the cross-sectional design limits the interpretability of the results.

Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms

BACKGROUND

Young Middle Eastern male refugees are currently among the most vulnerable groups in Europe. Most of them have experienced potentially traumatic events (PTEs) such as rape, torture, or violent assaults. Compared to their peers, young refugees suffer more from internalizing and externalizing symptoms, especially when unaccompanied. Little is known about the cumulative impact of experiencing different types of PTEs on mental health outcomes (polytraumatization) of young male refugees from the Middle East. We investigated (1) whether there is a dose-response relationship between multiple PTE types experienced and mental health outcomes, (2) whether individual types of PTEs are particularly important, and (3) to what extent these are differentially associated with mental health outcomes among unaccompanied or accompanied peers.

METHODS

In total, 151 young Middle Eastern male refugees in Germany (M_age = 16.81 years, SD_age = 2.01) answered questionnaires on PTEs, mental health, and post-migration stress.

RESULTS

Hierarchical regression analyses revealed, while controlling for age, duration of stay, unaccompanied status, and post-migration stress, (1) a dose-effect between PTE types on both internalizing and externalizing symptoms. Moreover, (2) regarding internalizing symptoms, violent family separation and experiencing life-threatening medical problems were particularly crucial. The latter was driven by unaccompanied refugees, who also reported higher levels of substance use.

CONCLUSIONS

The results extend findings from the literature and suggest that not only may greater polytraumatization be related to greater depression among refugees, but also to a range of other mental health outcomes from the internalizing and externalizing symptom domains. Furthermore, the results highlight the mental health risks that unaccompanied and accompanied refugee adolescents face after exposure to PTEs, and provide information for practitioners as well as researchers about event types that may be particularly relevant.

[Digital interventions for refugees. Challenges, opportunities, and perspectives of agency]

DEFINITION OF THE PROBLEM

Refugees show a high prevalence of mental health burden. Catering to the need for mental health services is made difficult by access barriers. These barriers consist of structural factors as well as culturally different attitudes towards mental health, mental illness, and therapeutic interventions. One option to overcome these access barriers and to provide mental healthcare services in an appropriate manner is seen in digital interventions. In the form of interactive websites or smartphone apps, these interventions have proven to be effective in mental healthcare. There are also promising examples of successful use of these technologies with refugees. However, the ethical aspects of digital interventions for refugees have scarcely been studied yet.

ARGUMENTS

Aim of this paper is to tackle this research desiderate. The instrument of the ethical analysis to be conducted is the concept of agency. According to the concept of agency, persons have to be seen as actors capable of acting based on their own resources and competencies. Agency is the guiding principle here for analyzing the opportunities and risks of digital interventions for refugees. In addition, I will attempt to point out prospects for an agency-based application of digital interventions.

CONCLUSION

The ethical analysis could be used as the blueprint for developing therapeutic concepts that contribute to the improvement of mental healthcare services for refugees from an ethical perspective.

Feasibility and Effectiveness of a New Short-Term Psychotherapy Concept for Adolescents With Emotional Dysregulation

Background: The 'Stress-Trauma-Symptoms-Regulation-Treatment' (START) is an innovative manualized short-term treatment program for stabilization and stress resilience in emotionally dysregulated adolescents, based on an approach of stress and management and emotional regulation. The current pilot trial aims to assess the feasibility and effectiveness of the START intervention program for improvement of emotion regulation. Methods: Sixty-six adolescents between the age of 13-18 years admitted to a psychiatric unit for acute emotional or behavioral dysregulation took part in the START program for 5 weeks in an open group setting with two sessions per week (70 min/session). Before treatment, we assessed a history of adverse experience with the Child and Adolescent Trauma Screen (CATS) and the Child Posttraumatic Cognitions Inventory (CPTCI). Before and after treatment, the participants completed the FEEL-KJ, a self-report screening instrument of emotional regulation and coping strategies. Results: A large proportion of this sample had experienced traumatic events based on the CATS (75%) and the CPTCI (82%). The mean FEEL-KJ score significantly decreased after the intervention (d = -0.248, p = 0.037), while no difference was observed with regard to mean level of adaptive emotion regulation strategies (d = 0.202, p = 0.207). A positive effect of the intervention was observed on three components of the adaptive FEEL-KJ scale: accepting (d = 0.289, p = 0.08), forgetting (d = 0.271, p = 0.049) and dealing with anger (d = 0.309, p = 0.034). Conclusion: START demonstrates preliminary evidence for improvement in emotional dysregulation after a 5-weeks course of treatment. Therefore, this short-term intervention can possibly be regarded as a tool to improve emotional stability in children with a high load of trauma-related psychopathology. The results are promising and warrant future studies, specifically randomized controlled trials on the effectiveness of START for strengthening resilience at-risk-populations.

[Mental Disorders among Refugees]

Mental Disorders among Refugees Abstract. Children and adolescents with migration and refugee backgrounds are subject to various health-related, psychosocial, sociocultural, and economic burdens that may influence the prevalence, manifestation, course, and treatment as well as prognosis of mental disorders. In addition, they are particularly disadvantaged by numerous barriers to accessing the mental healthcare and treatment granted natives. The so-called transition gap only exacerbates the situation. As a solution, we provide recommendations for improving the mental healthcare of children and adolescents with a migration and refugee background analogous to the situation for adults. For inpatient settings, where mental healthcare is inadequate, we recommend the establishment of so-called adolescent wards under child and adolescent and adult psychiatric-psychotherapeutic management, with appropriate nursing and therapeutic staffing as well as a special "transition management" including the training of intercultural competence.

Healthcare needs among unaccompanied minor refugees: a study protocol of a qualitative study explaining access and utilisation across place and gender

INTRODUCTION

Several studies have identified that unaccompanied minor refugees (UMRs) are allegedly 'vulnerable' and belong to a high-risk group in terms of psychological distress and post-traumatic stress disorder due to their preflight, periflight and postflight experiences. Psychosocial care (PSC) is of high importance for UMRs, but little is known about barriers to access and utilisation of PSC across place and gender. The aims of this gender-sensitive qualitative study will be to build on the existing body of literature and to provide qualitative evidence on the contexts and mechanisms of PSC for male and female UMRs in Germany by comparing two German regions.

METHODS AND ANALYSIS

Following the study preparing realist review, a qualitative study will be undertaken in Berlin and Central German cities. Approximately 24 experts from the field of PSC and 12 lay UMRs will participate in face-to-face, semistructured interviews. Data will be transcribed and analysed based on the grounded theory research paradigm.

ETHICS AND DISSEMINATION

Only participants who have been informed in both German and their native tongue and who have signed a declaration of consent will be included in the study. The study will comply rigorously with German data protection standards. Approval from the Ethical Review Committee at Martin Luther University Halle-Wittenberg, Germany has been obtained and granted. The results of the study will be presented at several conferences and will be published in high-quality, peer-reviewed international journals. The results will display a differentiated picture of the PSC of UMRs in Germany. Such knowledge is a precondition for a 'science of change' that translates explanations into practical recommendations on how to improve healthcare policies.

TRIAL REGISTRATION NUMBER

DRKS00018080.

Mental health in refugees and asylum seekers (MEHIRA): study design and methodology of a prospective multicentre randomized controlled trail investigating the effects of a stepped and collaborative care model

The sudden arrival of culturally diverse asylum seekers and refugees into Germany has created a strong demand for recognizing and appropriately treating those suffering from mental health issues. Due to many systemic, organizational, cultural and socio-linguistic barriers, psychiatric treatment of refugees is posing a major challenge to Germany's mental health care system. Thus, there is a need for alternative models that allow for increased access to adequate, effective and efficient culturally sensitive mental health care services. Here, we describe the Mental Health in Refugees and Asylum Seekers (MEHIRA) project, a multicentre randomized controlled trial investigating a stepped collaborative care model (SCCM) for providing mental health treatment in this vulnerable population. The proposed SCCM aims to decrease the aforementioned barriers. Adult and adolescent participants will be screened for depressive symptoms and matched to appropriate psychological interventions, including group-level interventions (START intervention, Empowerment/Gender-sensitive/Peer to peer), and other innovative, digital treatment approaches (Smartphone application). The therapeutic effect of the SCCM will be compared to TAU (treatment-as-usual). All interventions have been designed to be culturally sensitive, and offered in two different languages: Arabic and Farsi. The outcome of this study may contribute significantly to future clinical and legal guidelines in developing parallel and efficient new structures of treatment. Collected data will inform primary and secondary mental health care providers with recommendations concerning the design and implementation of effective treatment models and programmes. Guidelines and recommendations may also potentially be adopted by other host countries, developing countries and also in humanitarian aid programmes.

Borderland and Borderline: Understanding and Treating Adolescent Migrants in Crisis

Background::

Much of the literature on adolescent refugees has focused on their experiences of trauma, and trauma-focused psychotherapy has been emphasized. In addition to having experienced trauma, adolescents with refugee or migration backgrounds are confronted with distinct challenges in the process of identity formation. These problems result from the normal processes of identity formation and restructuring during adolescence (the socalled second individuation phase) complicated by their transition from their culture of origin to the new culture. This process has been called a third individuation phase. These teenagers live on the border between two worlds and are called borderland adolescents.

Method::

This paper describes the developmental processes of young migrants, using case examples to illustrate how the migrant experience affects development, particularly identity development.

Discussion::

Splitting, which is part of normal adolescent development, also occurs during the process of adaptation to a new culture. Although the process of splitting can support the integration into the new culture, it can also lead to dangerous polarization with borderline features. It is important to take this into account in psychotherapeutic work with borderland adolescents.

[Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities]

Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.

Herausforderungen im Fluchtprozess unbegleiteter Jugendlicher

Zusammenfassung. Spätestens seit 2015 ist ein Anstieg an Publikationen zu verzeichnen, die sich psychischen Belastungen von Geflüchteten widmen, wobei die Gruppe der unbegleiteten jungen Geflüchteten als besonders schutzbedürftig und vulnerabel für psychische Auffälligkeiten beschrieben wird. Fluchtphasenmodelle gehen von potentiell traumatisierenden Ereignissen im Herkunftsland, während der Flucht und im Aufnahmeland als mögliche Ursachen für psychische Belastungen aus, vernachlässigen jedoch im Fall von minderjährigen oder jungen volljährigen Geflüchteten die Besonderheiten der Adoleszenzphase, in der viele Jugendliche, unabhängig von ihrer Herkunft, mit einer Reihe von wichtigen Entwicklungsaufgaben konfrontiert sind. Die vorliegende Arbeit stellt eine theoretische Erweiterung von Fluchtphasenmodellen um adoleszenzspezifische Entwicklungsanforderungen aus einer kultursensiblen Perspektive dar und nimmt eine Spezifizierung dieser Modelle für junge unbegleitete Geflüchtete vor.

Begleitete minderjährige Geflüchtete

Zusammenfassung. Aufgrund erhöhter psychopathologischer Vulnerabilität bei minderjährigen Geflüchteten (MG), sind wirksame psychotherapeutische Interventionen versorgungsrelevant. Die Mehrzahl MG flieht im Familienverbund. Die Familie wirkt dabei einerseits als stabilisierende Ressource, anderseits als Stressor, so dass der Einbezug der Eltern in die Therapie von Bedeutung ist. Dieses Reviews gibt einen Überblick über den aktuellen Forschungsstand zur Wirksamkeit psychotherapeutischer Maßnahmen mit Familieneinbezug bei begleiteten minderjährigen Geflüchteten (BMG). Insgesamt konnten fünf Studien identifiziert werden. Für die Kinder wurden in vier der fünf, für die Mütter in zwei der fünf Studien signifikante Effekte berichtet. Insgesamt ist die Befundlage gering und die Qualität der Primärstudien oft unzureichend. Replikationen der Ergebnisse unter Berücksichtigung der methodischen Qualität sowie die Implementierung weiterer Maßnahmen sind notwendig.

Resilienztraining für unbegleitete minderjährige Flüchtlinge

Zusammenfassung. Die hohen Flüchtlingszahlen und die fortlaufende Ankunft schwer traumatisierter unbegleiteter minderjähriger Flüchtlinge (UMF) verschärfen die Suche nach wirksamen und niederschwelligen Präventions- und Interventionsprogrammen. Die vorliegende Pilotstudie evaluiert die Effektivität eines nicht-indizierten, sechs Sitzungen umfassenden Resilienztrainings für UMF. Teilnehmende (N = 55) wurden in einem randomisiert-kontrollierten Wartelistendesign vor (T1) und nach (T2) dem Gruppenprogramm untersucht. Abhängige Variablen waren das allgemeine Wohlbefinden sowie Symptome von Traumafolgestörungen. Weiter wurden aus mehreren Perspektiven (Teilnehmer, Dolmetscher, Gruppenleitende, Betreuende) qualitative Daten erfasst. Während Traumafolgestörungssymptome unverändert blieben, berichtete die Interventionsgruppe nach dem Programm einen Anstieg im Wohlbefinden, nicht jedoch die Kontrollgruppe. Die qualitativen Daten wiesen perspektivenübergreifend auf positive Veränderungen in mehreren Funktionsbereichen hin. Ein kurzes Resilienztraining hat somit das Potential Verbesserungen zu bewirken. Für eine Minderung von Traumafolgestörungssymptomen sind jedoch wohl längere bzw. traumaspezifischere Interventionen erforderlich.

Hair cortisol, lifetime traumatic experiences and psychopathology in unaccompanied refugee minors

Attenuated cortisol secretion has been linked to traumatic experiences and the developmental psychopathology. Unaccompanied refugee minors (URM) form a highly vulnerable group in this context, usually exposed to multiple and severe traumatic experiences and characterized by a high, comorbid symptom-load. Here, we provide a first investigation in URM seeking to elucidate associations between long-term cortisol output, assessed through hair cortisol concentrations (HCC), lifetime traumatic events and psychological symptoms. Ninety-one male URM from Syria and Afghanistan (mean age = 17.4 years), living in group homes of the Child Protection Services in Leipzig, Germany, were examined. HCC were measured from scalp-near 3 cm hair segments and data on LTE, PTSD symptoms, depression, anxiety and somatic symptoms as well as emotional and conduct problems assessed. Results revealed HCC to be negatively related to lifetime traumatic events (total number, trauma types). In addition, a tentative finding of a positive association between HCC and emotional problems emerged. Results are discussed with regard to their relevance for HCC as a biomarker of the long-term endocrine consequences of chronic adversity and trauma exposure.

Alone, but protected? Effects of social support on mental health of unaccompanied refugee minors

Unaccompanied refugee minors (URM) are the most vulnerable group of refugees suffering from higher levels of mental health problems. Yet, there is also a group of URM with little or no symptoms or disorders. A major predictor for positive mental health outcomes is the social support network in the post-flight period which has rarely been investigated for the group of URM. The present study analyzes differences between perceived social support from family, peers, and adult mentors in URM, with subgroup analyses of peer and mentor support in URM with and without family contact. Furthermore, we investigate whether social support from each of the three sectors moderates the relationship between stressful life events (SLE) and mental health of URM with family contact. Questionnaire data were collected from 105 male URM from Syria and Afghanistan aged 14-19 years who were living in group homes of the Child Protection Services in Leipzig, Germany, in summer 2017. URM receive most social support from their families, followed by peers and adult mentors. URM without family contact received less peer and mentor support compared to URM with family contact. Lower social support from mentors increased the risk for PTSD, depression and anxiety symptoms after SLE, whereas lower social support from peers increased the association between SLE and anxiety symptoms. Mentor and peer support in the host country is relevant for the processing of SLE. URM without family contact represent a "double burden" group, as they might feel less supported by other social networks.

Health of Syrian unaccompanied asylum seeking adolescents (UASA) at first medical examination in Germany in comparison to UASA from other world regions

BACKGROUND

The war in Syria has led to the biggest refugee crisis of our time. Unaccompanied asylum seeking adolescents (UASA) are a particularly vulnerable subgroup of refugees. This study aims to describe the weight status, health behaviour and disease spectrum of Syrian UASA in comparison to UASA from other world regions.

METHODS

The study was conducted as a prospective cross-sectional analysis of health metrics and diagnoses from 346 UASA (78% male; mean age 16 years) between 2011 and 2017. The data was collected in an outpatient clinic for internal and tropical medicine during a systematic medical examination after arrival. Descriptive and bivariate analyses stratified by gender and region/country of origin were performed.

RESULTS

The general health status of the UASA in most cases was good. Compared to other UASA Syrian UASA had the highest underweight prevalence (16.7%) (p = .013) and the second highest smoking prevalence (37.9%) (p < .001). Diseases at first medical examination mostly were infections and diseases of the digestive system, with significant differences between the regions/countries of origin (p < .001; p < .001, respectively). Syrian UASA had a lower prevalence of infections (28%) and a similar prevalence of mental and behavioural problems (10.3%) than the average of all regions/countries of origin (48.6%; 11%, respectively).

CONCLUSION

Tailored screening for diseases as well as for health behaviour immediately after arrival in Germany is needed to reduce the individual burden of disease and to offer targeted preventive measures.

Prevalence of mental disorders in young refugees and asylum seekers in European Countries: a systematic review

The European Union member states received about 385,000 asylum applications from children and adolescents below 18 years in 2015, and 398,000 in 2016. The latest political crises and war have led to an upsurge in refugee movements into European countries, giving rise to a re-evaluation of the epidemiology of psychiatric disorders and mental health problems among young refugees and asylum seekers. We systematically searched five electronic databases and reference lists of pertinent review articles. We then screened the results of forward citation tracking of key articles for relevant studies in the field for the period from January 1990 to October 2017. We dually reviewed citations and assessed risk of bias. We reported the results narratively, as meta-analyses were impeded due to high heterogeneity. We included 47 studies covered in 53 articles. Overall, the point prevalence of the investigated psychiatric disorders and mental health problems varied widely among studies (presenting interquartile ranges): for posttraumatic stress disorder between 19.0 and 52.7%, for depression between 10.3 and 32.8%, for anxiety disorders between 8.7 and 31.6%, and for emotional and behavioural problems between 19.8 and 35.0%. The highly heterogeneous evidence base could be improved by international, methodologically comparable studies with sufficiently large sample sizes drawn randomly among specific refugee populations. The prevalence estimates suggest, nevertheless, that specialized mental health care services for the most vulnerable refugee and asylum-seeking populations are needed. REGISTRATION: The systematic review protocol was registered in PROSPERO on October 19th, 2017 with the number: CRD42017080039 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=80039.

Gender differences in the mental health of unaccompanied refugee minors in Europe: a systematic review

OBJECTIVES

Our aim was to summarise the current evidence regarding gender differences in the mental health of unaccompanied refugee minors (URM) and to identify gaps in research.

SETTING

We focused on quantitative studies presenting primary data from Organisation for Economic Co-Operation and Development(OECD)countries. Language was restricted to English or German.

PARTICIPANTS

To be eligible, a study had to involve (former) URM who immigrated to an OECD country.

DESIGN

We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases MEDLINE, CINAHL, LIVIVO, PSYNDEX and PsycINFO were searched from 1990 to 2017. Studies were judged for eligibility by two independent reviewers each. We narratively summarised our results.

RESULTS

9 primary studies, all from Europe, examined gender differences in the mental health of URM. The majority of the included studies found female URM to be more often affected by post-traumatic or depressive symptoms than their male counterparts. There is only weak evidence regarding other mental health outcomes. Two studies each conducted gender-specific analyses on anxiety and externalising behaviour, but no statistically significant differences between female and male URM were detected.

CONCLUSIONS

Female gender is associated with a higher vulnerability towards certain mental health problems among URM residing in Europe. However, the lack of representative studies using reliable diagnostic methods indicates that the findings so far should be treated with caution. Further research is needed to clarify the role of gender for mental health in URM and to examine underlying mechanisms.

Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services

This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.

[START - Development of an Intervention for a First Stabilization and Arousal-modulation for Highly Stressed Minor Refugees]

START - Development of an Intervention for a First Stabilization and Arousal-modulation for Highly Stressed Minor Refugees This article focuses on the development of an intervention called "Stress-Traumasymptoms- Arousal-Regulation-Treatment" (START), through the process of working with refugeed minors in acute stress during the clearing process immediately on arrival in Germany. START is a short manualized structured intervention for crisis intervention and stabiliziation of children and adolescents suffering from intense stress and acute tension or desperation. It consists of five sessions preferred for group or also single treatment. For easy and widespread applicability we translated the START-Manual in Dari, Arab and English. The language is simple and easily understandable and illustrated by picture material. For children incapable of reading there is also an audio version in the different languages. Some compounds of START are derived from elements of dialectic behavioral therapy (Linehan, 2015; Rathus u. Miller, 2015; Bohus u. Wolf, 2011) and traumafocused cognitive behavioral therapy for children (Cohen, Mannarino, Deblinger, 2009). The manual can be used by psychotherapists, social workers, physicians, school psychologists as well as qualified caretakers, given the highly self-instructive character of the instrument. In clinical settings, children of all cultural backgrounds can and should be included in the group treatment. START was very readily accepted by the refugeed children and adolescents and observed to reduce stress in children and supervising professionals. Its efficacy and effectiveness is currently target of a standardized pre-post evaluation. Clinical implications as well as limitations of the concept are discussed.

Promoting Mental Health in Unaccompanied Refugee Minors: Recommendations for Primary Support Programs

During the last years, the number of refugees around the world increased to about 22.5 million. The mental health of refugees, especially of unaccompanied minors (70% between the ages of 16 and 18 years) who have been exposed to traumatic events (e.g., war), is generally impaired with symptoms of post-traumatic stress disorder, depression, and anxiety. Several studies revealed (1) a huge variation among the prevalence rates of these mental problems, and (2) that post-migration stressors (e.g., language barriers, cultural differences) might be at least as detrimental to mental health as the traumatic events in pre- and peri-flight. As psychotherapy is a limited resource that should be reserved for severe cases and as language trainings are often publicly offered for refugees, we recommend focusing on intercultural competence, emotion regulation, and goal setting and goal striving in primary support programs: Intercultural competence fosters adaptation by giving knowledge about cultural differences in values and norms. Emotion regulation regarding empathy, positive reappraisal, and cultural differences in emotion expression fosters both adaptation and mental health. Finally, supporting unaccompanied refugee minors in their goal setting and goal striving is necessary, as they carry many unrealistic wishes and unattainable goals, which can be threatening to their mental health. Building on these three psychological processes, we provide recommendations for primary support programs for unaccompanied refugee minors that are aged 16 to 18 years.

Evaluation eines migrationsspezifischen Angebots im Case Management von Kindern und Jugendlichen mit Therapiebedarf nach Misshandlung, Missbrauch oder Vernachlässigung

Zusammenfassung. Für Kinder und Jugendliche aus Familien mit Migrationshintergrund (MHG) ist der Zugang zu evidenzbasierter Psychotherapie möglicherweise erschwert. Im Rahmen einer randomisierten und kontrollierten Multicenter-Studie zur Evaluation eines Case Management-Ansatzes für Kinder und Jugendliche, die nach Misshandlung, sexuellem Missbrauch oder Vernachlässigung eine psychische Störung entwickelt haben, wurden zur Projektmitte die beteiligten Case Manager zusätzlich hinsichtlich kultur- und migrationsspezifischer Aspekte geschult und in ihrer Arbeit mit Migrantenfamilien durch übersetzte Materialen und die Finanzierung von Dolmetschern unterstützt. Obwohl mit einem Anteil von 30 % Fällen mit MHG in der Interventionsstudie die anvisierte Zielgruppe erreicht wurde, waren die Fallzahlen im Case Management-Arm mit n = 7 vor der migrationsspezifischen Schulung und n = 8 danach zu gering, um einen klinischen Nutzen der Maßnahmen im Sinne einer besseren Versorgung nachzuweisen.

Evaluation of a Trauma-Focused Group Intervention for Unaccompanied Young Refugees: A Pilot Study

Recent research has shown that unaccompanied young refugees (UYR) encounter a wide range of traumatic events during preflight, flight, and resettlement. Although many UYR are resourceful, many develop posttraumatic stress symptoms (PTSS). However, only a small number of vulnerable UYR have access to trauma-focused interventions. Trauma-focused group interventions, adapted to the needs of UYR, may be one way of improving their mental health. A total of 29 male UYR between 14 and 18 years of age, mainly from Afghanistan, participated in the evaluation study of a trauma-focused group intervention entitled Mein Weg (My Way). The intervention included six sessions of psychoeducation, relaxation, trauma narrative, and cognitive restructuring. Pre-post comparisons of PTSS assessed by the Child and Adolescent Trauma Screen (CATS) were used. At study entry, participants endorsed, on average, eight traumatic events. After the group intervention, the participants reported significantly fewer overall PTSS preintervention mean = 27.6, SD = 7.9; postintervention mean = 20.7, SD = 6.3; t(28) = 4.2, p = .001, Cohen's d = 0.97. Improvement was especially pronounced in the domains of reexperiencing and avoidance, as well as negative alterations in cognitions and mood. There were 14 participants preintervention and 7 postintervention who fulfilled the PTSD criteria. This pilot study presented initial evidence of the efficacy of the trauma-focused group intervention with regard to PTSS reduction.

Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review

Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.

[Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders]

Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.

[Diagnostics and initial estimation of refugee minors]

The number of underage refugees arriving in Germany has rapidly increased since 2015. Many of these children and adolescents have been and still are, exposed to a large number of stressful circumstances. The group of those helping refugee minors is heterogeneous with both volunteers and professional workers from the fields of child welfare and healthcare services. Easily applicable instruments to assess both burdens and resources are needed in order to plan appropriate interventions. This paper focuses on instruments for assessing the circumstances of refugee minors and includes pilot data of an online-based screening instrument to assess burdens and resources (providing online resource and trauma assessment for refugees, PORTA). Field application was tested by the staff of a clearing and preclearing institution with 33 cases and good practical feasibility was reported. Applying a simple to use screening instrument for refugee minors and their helpers, which is available in several languages creates the possibility of a shared definition of problems and solutions and is beneficial to helpers (e.g. volunteers, youth welfare services and medical doctors) as well as refugee minors.

[Mental treatment of refugees in Germany : Model for a stepped approach]

The recent influx of refugees and asylum seekers into Germany poses a challenge for the national healthcare system. In compliance with the present Asylum Seekers Benefits Act, the national healthcare system can be expected to have 1.5 million new members by early 2017. Providing adequate care particularly for people with mental illnesses or disorders will represent an immense challenge for all actors in the system. The circumstances of the flight combined with the foreign linguistic and socio-cultural background increase the severity of the cases and the difficulties of treatment. No procedures or guidelines for treatment have yet been established to ensure a standardized, cost-efficient and therapeutically effective treatment of patients with this background. This article describes the components of a stepped treatment procedure and proposes a stepped and collaborative care model (SCCM) that could be evaluated in nationwide studies. This approach is based on national and international treatment guidelines and aims to provide target-group specific, culturally sensitive methods of diagnosis and treatment. The various steps of the model build on each other, with the first steps relying on technological aids (e.g. online or smartphone options) and support from lay helpers and the more expensive specialist psychiatric and psychotherapeutic therapy only being initiated in cases of more severe mental disorders.

Unaccompanied refugee minors in Germany: attitudes of the general population towards a vulnerable group

Germany saw an increase in numbers of refugees in 2015, with nearly a third being below the age of 18. Unaccompanied refugee minors (URMs) present an especially vulnerable group. In addition to pre-flight and flight stress, the acculturation process can work as potential stressor, and we wanted to explore attitudes towards URM. We conducted a study in a representative sample (n = 2524) of the German population (ages 14 years or older) between January and March 2016. Only 22.8% of participants thought that Germany could accompany more URM. While few participants argued in support of immediate deportation of URM in general (38.6%) or of URM from the Middle East (35.3%), a majority advocated for immediate deportations of URM from the Balkan region (62%) or from Africa (51.1%). Difference in the variance regarding attitudes towards deportation was explained mostly by right-wing political attitudes as well as by islamophobic attitudes and general rejection of asylum seekers. High rates of approval were found for guaranteeing the same chances to schooling or apprenticeship for URM as to German children and for bestowing URM a right to permanent residence if they were able to complete school or apprenticeship. Education and qualification are key to integration. Studies about needs and wishes of URM consistently report a high motivation to learn the language of their new host country and attend school. At this point, hopes of URM and expectations of society meet, which underlines the importance of participation in education as key factor in integration.

[Unseen Suffering - Therapy for Traumatized Refugee Children]

Unseen Suffering - Therapy for Traumatized Refugee Children In March 2015 the psychological counselling service (Psychologische Familien- und Lebensberatung) of Caritas Ulm initiated a psychotherapy project for traumatized minor refugees. Besides individual and group therapy, networking and qualification of qualified personnel and volunteers, in autumn 2015 we started offering our services on-site in a large collective accommodation for asylum seekers in Ulm. This was mainly because - in contrast to unaccompanied, mostly adolescent, minor refugees - our services appeared to reach children only by chance. In our opinion this is mostly due to the fact that children's suffering is often far less noticed. This paper describes our first year's project work, followed by reports on the use of psychodrama groups with refugee children and on the therapeutic work in a collective accommodation for asylum seekers.

Psychische Auffälligkeiten von Flüchtlingskindern

Zusammenfassung. Die gestiegenen Flüchtlingszahlen in den letzten Jahren werden von einer erhöhten Forschungstätigkeit begleitet. Viele dieser Studien in der Klinischen Kinderpsychologie und Kinder-/Jugendpsychiatrie beschäftigen sich dabei mit psychischen Auffälligkeiten bei Flüchtlingskindern, insbesondere der Posttraumatischen Belastungsstörung und depressiven Symptomen. Als Ursache dieser Auffälligkeiten werden dabei vor allem traumatisierende Erlebnisse vor oder während der Flucht angenommen. Diese traumafokussierte Sichtweise greift jedoch zu kurz, da sie (a) Prozesse von Resilienz (b) den Einfluss von Akkulturation auf das psychische Befinden und (c) die unmittelbare Erfüllung von primären Grundbedürfnissen nach einer Flucht vernachlässigt.

Flüchtlingskinder

Zusammenfassung. Die Anzahl und die kulturelle Verschiedenheit der unbegleiteten Kinder und Jugendlichen, die in den letzten Monaten nach Deutschland gekommen sind, stellen eine große Herausforderung dar. Soziale Integration bildet die generelle Anforderung, wobei die Vielzahl der Erwartungen, unterschiedliche Wertesysteme und psychische Belastungen Barrieren einer erfolgreichen Integration bilden. Psychologische und therapeutische Maßnahmen sowie Angebote der Jugendhilfe können viele Probleme abfangen und als umfassendes Betreuungsangebot wertvolle Dienste leisten.

Verhaltensauffälligkeiten und Lebensqualität bei männlichen unbegleiteten minderjährigen Flüchtlingen in Jugendhilfe einrichtungen in Deutschland

Zusammenfassung. Unbegleitete minderjährige Flüchtlinge (UMF) gelten als Hochrisikogruppe für die Entwicklung psychischer Erkrankungen. Hinsichtlich Häufigkeit und Art psychischer Störungen sowie gesundheitsbezogener Lebensqualität (LQ) fehlen für Deutschland bislang Originalarbeiten. Anhand der Daten von 191 männlichen UMF, erhoben in Jugendhilfeeinrichtungen in Deutschland, wurden emotionale und Verhaltensauffälligkeiten (SDQ) sowie gesundheitsbezogene LQ (ILK) untersucht und Vergleiche zur Normstichprobe durchgeführt. Internalisierende Verhaltensauffälligkeiten zeigten sich laut Selbst- und Fremdbeurteilung bei 35 bis 61 % der Jugendlichen signifikant häufiger als in der Normstichprobe (20 %). Hyperaktivitätssymptome waren dagegen sehr selten (4 bis 7 %). Externalisierende Verhaltensprobleme wurden von Betreuungspersonen häufiger (20 %) berichtet als von den Jugendlichen (8 %). Gesundheitsbezogene LQ wurde niedrig eingeschätzt, als Ressource konnte prosoziales Verhalten identifiziert werden.

Unbegleitete minderjährige Flüchtlinge

Zusammenfassung. Angesichts der aktuellen Flüchtlingsproblematik und der hohen Prävalenz psychischer Störungen bei Flüchtlingen stellt sich die Frage nach wirksamen Interventionen zur psychotherapeutischen Versorgung insbesondere minderjähriger Flüchtlinge. Das Review bietet einen Überblick über den aktuellen Forschungsstand zur Wirksamkeit verschiedener therapeutischer Interventionen bei unbegleiteten minderjährigen Flüchtlingen (UMF). Durch eine Recherche von acht Datenbanken wurden 12 Studien identifiziert, die mittels Prä- und Postmessungen psychologischer Outcomes in quantitativer Form über die Wirksamkeit psychotherapeutischer Interventionen bei UMF berichten. Mittels statistischer Informationen wurden außerdem Effektstärken berechnet. Zehn der zwölf Artikel berichteten signifikante Ergebnisse, wenngleich die Befundlage insgesamt dünn und die methodische Qualität oft mangelhaft ist. Replikationsstudien von hoher methodischer Qualität sowie die Erforschung weiterer Maßnahmen, beispielsweise multimodaler psychosozialer Unterstützungsprogramme und im schulischen Kontext, aber auch von potentiellen Moderatoren und Mediatoren, sind notwendig.

[A complex crisis intervention for a 16-year-old pregnant girl after unaccompanied emigration from Eritrea]

Unaccompanied refugee minors are frequently confronted with multiple, potentially traumatizing events; girls tend to show most profound traumatizations. A 16-year-old female refugee minor was admitted to a child psychiatric ward over the weekend for acute suicidal behavior. The girl had fled unaccompanied from Eritrea and was living in a shelter home for adolescents. Pregnancy (23 weeks p. c.) had been diagnosed the previous day, stemming from several rapes that had occurred on her journey through Sudan and Nigeria. The girl had repressed all signs of the pregnancy from her consciousness. However, when it became medically undeniably apparent, she tried to end her life by jumping out of a window. The shelter home staff requested a psychiatric indication for termination of the pregnancy. Implications of medical indications for psychiatric reasons at a pregnancy state of 23 weeks as well as ethical aspects and considerations with regard to posttraumatic symptomatology are discussed in the following case report.

[The proportion of unaccompanied refugee minors suffering from psychiatric disorders in Germany]

Objective

This article is the first investigation into the proportion of unaccompanied refugee minors suffering from psychiatric disorders in Germany. Method: In a retrospective study done between 2013 and 2015, any refugees showing symptoms of a psychiatric disorder during their stay in a residential refugee center were referred to an Outpatient Department of Child and Adolescent Psychiatry for diagnostic assessment. To this end, special consultation hours were arranged. Besides the diagnoses, the number of emergency consultations occurring before and after the implementation of the special consultation hours was recorded.

Results

Of the 75 refugee minors (75 %) referred, 56 were suffering from a psychiatric disorder, with posttraumatic stress disorder and depression being the most common diagnoses. Following implementation of the consultation hours, the number of refugee patients initially admitted in the Child and Adolescent Psychiatry on an emergency basis fell.

Conclusions

Unaccompanied refugee minors are a highly vulnerable group that poses great challenges to clinical care. The implementation of special consultation hours is a constructive option for meeting these challenges. In particular, this special offer enables improvement of crisis management in the case of emergency consultations.