Family unit in a children's psychiatric hospital

Wirksamkeitsüberprüfung einer kinderpsychiatrischen Eltern-Kind-Station unter klinischen Routinebedingungen

Zusammenfassung. Vor dem Hintergrund der komplexen Wechselwirkung zwischen der Entstehung und Aufrechterhaltung psychischer Störungen im Kindesalter einerseits und familiären Kontextbedingungen andererseits, bieten Eltern-Kind-Stationen die vielversprechende Möglichkeit das familiäre Umfeld intensiv in die kinderpsychiatrische Behandlung mit einzubeziehen. Um die Wirksamkeit dieser speziellen Therapieform zu untersuchen, wurden im Rahmen einer monozentrischen Fragebogenstudie unter klinischen Routinebedingungen im Ein-Gruppen-Prä-Post-Design anhand einer Stichprobe von 60 Familien die kindliche Symptombelastung (CBCL) und das elterliche Stresserleben (ESF) zu drei Zeitpunkten (Diagnostikblock, Beginn Therapieblock, Therapieende) erhoben. Während sich in der Wartezeit bis Therapiebeginn keine bedeutsamen Veränderungen zeigten, reduzierten sich im Verlauf der Behandlung sowohl die kindlichen Verhaltensauffälligkeiten als auch das elterliche Stresserleben signifikant. Damit liefern die vorliegenden Ergebnisse nicht nur einen Hinweis auf die therapeutische Effektivität kinderpsychiatrischer Eltern-Kind-Stationen, sondern untermauern bisherige Untersuchungen zur engen Verzahnung von kindlichen Verhaltensauffälligkeiten und elterlichen Stresserleben.

Parental substance abuse and suspected child abuse/maltreatment predict outcome in children's inpatient treatment

There has been relatively little empirical study of outcome for school aged children treated in psychiatric hospitals. In earlier studies, four preadmission variables were operationally defined and studied as hypothesized predictors of poor outcome in psychiatric day treatment by the criterion of recommended in-home or out-of-home placements on discharge. The preadmission variables are recent histories of severe aggression and suicidal ideation/behavior in the child and histories of parental substance abuse and reported suspicions of child abuse/maltreatment. In this study, the work has been extended to determine if these four preadmission factors relate to outcome of children treated in inpatient hospitalization. The findings indicate that the parent/family related variables, and not the child variables (nor child diagnosis), are significantly related to out-of-home recommended placements.

Admitting whole families: an alternative to residential care

This paper is an examination of the effectiveness of a programme (described in detail elsewhere) designed to admit whole families for short-term intensive assessment and treatment. The goals of this programme are to eliminate residential care for symptomatic children who are admitted with their families to this service, to decrease the length of stay of the symptomatic child in residential treatment, if this is required following admission of the whole family to this unit, and to provide these services at costs comparable to or less than that currently being spent with conventional residential treatment. Results stemming from a number of pre- and post-treatment measures indicate that one half of the children initially assessed and recommended for inpatient treatment had successfully avoided inpatient treatment for six months following admission of their family to this unit. For children recommended for residential care after admission of their families to the family unit, a reduction of approximately 35% of total time in residence occurred (when compared with a comparison group). A cost saving of over +12,000 per case was realized as a result of admission of the whole family when compared with residential treatment.

Family admission policy in a child psychiatric unit

The literature on residential admissions of whole families to psychiatric facilities is reviewed. Over the past decade, several child and family psychiatric centres have become the focus of innovative family admission programs. When a child or family presents with serious psychiatric problems, the availability of such programs dramatically increases the effective assessment and treatment options available. The benefits of a whole family admission policy are outlined and illustrated by a case example. In some cases, a brief family admission circumvents the need for a lengthy admission of the child alone. Disadvantages and contraindications are described. The adoption of a set of criteria and a specific policy for family admissions in a child psychiatric residential unit has challenged its organisational structure. The conceptual framework applied to requests for admission has broadened and been complemented by creative program development within the centre for children and families.

The effectiveness of child psychiatric inpatient care

After 900 admissions there is evidence that the programme for the inpatient hospitalization of psychiatrically ill children for a pre-determined period, can provide effective treatment. The time limited aspect appears to maximize the utilization of staff and family time. Parents' reports, rating scale information and assessments of outcome seem to agree that most children benefit. While hospitalizing the most difficult cases, the 29 day stay, 2% referral rate to foster homes and 7% re-admission rate of this unit, compares favourably with other child psychiatric units.

An application of strategic family therapy to a residential child and family psychiatry service: Redbank House

This paper describes the application of strategic family therapy as the core treatment model in a teaching hospital child and family psychiatry service providing outpatient and residential care. The admission of the whole family is seen as a desirable innovation in that it may prevent the process by which admission of the troubled child acts as reinforcement to, and a continuation of, family dysfunction.

Child abuse: a literature review

The following is a summary of a recently published review of Swedish and international literature concerning children exposed to abuse and neglect or manifesting failure to thrive. The review is the first report appearing from the so-called PRU group in Uppsala--Psycho-social Risk Children in Uppsala. The group is a multidisciplinary team engaged in a research project about Uppsala children exposed to mental, social and physical risks in their homes. The project is financed by the Save the Children Fund, which has also contributed to the printing costs of the book. Various professions are represented in the research team, namely social work, family therapy, child psychiatry, child psychology, paediatrics, and sociology. The complete review was published in the autumn of 1977 under the following title: Dagmar Lagerberg/PRU-gruppen: Föräldravåld mot barn. En litteraturstudie (PRU group: Child abuse by parents. A literature review). A second main report, presenting the aims, material, methods, and results of the project, is planned for publication in 1979.

General practice observed. Child abuse and general practice

In a general practice of 9250 patients with 1841 children under 10 there were 12 cases of actual abuse during 1973-6. In March 1976 30 children were at risk. A preventive scheme was set up and the short-term outcome was good. There were no cases of serious abuse among the children at risk.

Ill-health and child abuse

Intensive therapeutic work with families, in which child abuse had occurred, suggested that bonding failure related in part to the pregnancy, perinatal experience, and early ill-health of the abused proband and parents. 25 consecutive unequivocally abused children who had 1 or more siblings were selected from our referrals. Six factors emerged as highly significantly over-represented in the proband biography as compared with the control sibling group: abnormal pregnancy, abnormal labour or delivery, neonatal separation, other separation in the first six months, illnesses in the first year of life, and illness in the mother in first year of life. These data suggest that treatment of parents during pregnancy the perinatal period, and early infancy may well be fruitful in the prevention of child abuse.