Inanspruchnahme von Hilfe und Versorgung bei psychischen Auffälligkeiten im Kindergartenalter

[Implementation of a novel form of care for the early detection and prevention of emotional and behavioral problems in children in the pediatric setting: Qualitative interviews with pediatricians, practice staff and parents]

AIM OF THE STUDY

Evaluation of the implementation of a standardized screening using the Strengths and Difficulties Questionnaire (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and/or to further counselling and treatment services.

METHODS

1.) Semi-structured interviews were performed with participating pediatricians (n=4), practice staff (n=4) and custodians of screened children (n=17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n=34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services.

RESULTS

In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e.g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families' use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n=11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians "completely" or "rather" agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care.

DISCUSSION

The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services.

CONCLUSION

An adoption of the novel form of care (SDQ screening and targeted allocation to indicated preventive programs and further services) to standard pediatric care unfolds its benefits if preventive and care services for EBPs in children are made available nationwide.

Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children

Stigmatizing attitudes towards mental disorders influence parents’ help-seeking behavior for their child’s mental health problems. As untreated mental disorders can cause morbidity and mortality, such parental attitudes are a serious barrier for public health promotion. Therefore, the help-seeking readiness in a distressed child’s broad social environment is essential. However, the role of stigma was unexplored in this context. This study empirically investigated the influence of adults’ stigmatizing attitudes towards mentally disabled people on their readiness to seek professional help for children’s mental health issues. Data from a representative German sample (N = 1906; 52% female) were collected between July and October 2021. A heteroscedastic ordered probit model was used for estimation. An empirical analysis provides evidence for a significant negative relationship between adults’ stigmatizing attitudes and their readiness to initiate mental health support for children (ß = −0.01; p < 0.001). Support acceptance seems to be independent of having children. To tackle stigmatizing attitudes and to promote public health, mental health literacy should be fostered through broad-based approaches. Awareness should be raised that children are also entitled to mental health care, just as they are in other health areas. Policy makers need to promote comprehensive information about mental illnesses and create incentives for acute and preventive service use.

Welche psychosozialen Belastungen weisen Familien mit einem Kind mit einer Entwicklungsauffälligkeit auf und welche Unterstützungsangebote nutzen sie?

Zusammenfassung. Theoretischer Hintergrund: Früherkennung bei Entwicklungsauffälligkeiten (EA) ist wichtig, insbesondere wenn diese mit psychosozialer Belastung einhergehen. Fragestellung: Bisher ist wenig darüber bekannt, wie sich die Belastungssituation bei Familien mit Kind mit EA im Alter von 0 – 3 Jahren verändert und welche Unterstützungsangebote sie nutzen. Methode: 779 Eltern schätzten EA für ihr Kind in den Bereichen Kommunikation, Fein- und Grobmotorik, Problemlösekompetenz und Soziale Entwicklung ein und 765 Eltern füllten einen Fragebogen zu psychosozialen Belastungen (T1 und T2) aus. Ergebnisse: 30,6 % der Kinder zeigen eine EA. Die kumulierte Belastung ist bei Familien mit Kind mit EA erhöht. Im Bereich der Kommunikation, Feinmotorik und Problemlösekompetenz zeigt sich ein stärkerer Anstieg der Belastungskumulation, wenn keine Frühförderung genutzt wurde. Diskussion und Schlussfolgerung: Die elterliche Einschätzung beim frühen Erkennen einer EA sollte stärker in Betracht genommen werden.

Hilfebedarf und Hilfesysteme für Kinder und Familien

Zusammenfassung. Für Kinder und Jugendliche mit psychischen und Verhaltensstörungen sowie Entwicklungsstörungen existiert in Deutschland ein differenziertes Angebot an Hilfen. Dieses reicht von der Pädiatrie, über die Kinder-/Jugendpsychiatrie, die ambulante Psychotherapie bis zur Kinder- und Jugendhilfe und zu schulischen Fördermaßnahmen. Die Effizienz dieser Hilfesysteme hängt auch von deren Vernetzung und interdisziplinären Kooperation ab. Die Lösung von Schnittstellenproblemen steigert Therapieerfolge und verbessert die Langzeiteffekte.

[Parents' and Childcare Teachers' Agreement on Mental Health Problems, Psychosocial Ressources and Need for Action]

Parents' and Childcare Teachers' Agreement on Mental Health Problems, Psychosocial Ressources and Need for Action Young Children with mental health problems rarely receive professional help. Recognising a problem is one key factor for mental health care utilisation in kindergarten age. In this study psychosocial problems and ressources of 255 children (age 3,0-6,6 years) were assessed by parents and childcare teachers with the instrument "Verhaltensskalen für das Kindergartenalter" (VSK, Koglin u. Petermann, 2016). Subjective need for action was also measured. Teachers announced a need for action in 19.8 % of the children, while parents did so for 17.3 % of the children, but they agreed only for 18.9 % of these children. So agreement on need for action was low (κ = .16). Agreement was also low for psychosocial problems (Median ICC = .32), and very low with respect to the borderline/clinical range (κ = .13). No agreement was found for psychosocial ressources. Results underline the importance for Early Education and Care professionals to cooperate with institutions like social-pediatric centers to avoid blind spots in the identification of mental health problems in preschool age.

Kleinkind- und Kindergartenalter

Zusammenfassung. Die Kenntnis früher Entwicklungsrisiken und Schutzfaktoren tragen dazu bei, abweichende Entwicklungen in der Kindheit rechtzeitig zu erkennen und Therapieschritte einleiten zu können. Die Ursachen einer abweichenden Entwicklung umfassen sowohl Schwangerschaftsrisiken, frühe Umwelteinflüsse und ungünstige biologische Faktoren als auch sozioökonomische, familiäre und partnerschaftsbezogene Einflüsse. Gut geplante Längsschnittstudien tragen dazu bei, die Startbedingungen von Kleinkindern und ihrer Entwicklung in den ersten Lebensjahren systematisch zu dokumentieren. Längsschnittstudien bilden auch das entscheidende Fundament, um Präventionsmaßnahmen zu begründen und in ihrer Wirksamkeit zu überprüfen.