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Die systematische und bewusste Einarbeitung neuer Mitarbeiter*innen wird oftmals vernachlässigt. Dabei fühlen sich neue Mitarbeiter*innen bei systematischer Einarbeitung wie z.B. durch "echte Probezeit" und "Patensysteme" schnell in einer Einrichtung integriert. Damit einher geht die zügige und für das Team spürbare Mitarbeit der/des neuen Kolleg*in. Gleichzeitig kann durch systematische Einarbeitung auch erkannt werden, wenn keine ausreichende Passung zwischen dem Team und der/des neuen Kolleg*in vorhanden ist oder die Leistung der/des neuen Kolleg*in für das Aufgabenfeld nicht ausreicht. Der Beitrag gibt praxisorientierte Hinweise dazu, wie die Probezeit sinnvoll genutzt werden kann.
Male juveniles in segregated poor neighbourhoods are at increased risk of violence. The code of the street approach is commonly used to understand the context informing street violence in such marginalized spaces, but the concept is mainly used in Western countries, especially in African American communities in the US. This study investigates whether the code of the street is also applicable to the largest Roma neighbourhood in Europe, located in Bulgaria, through guided interviews with male juveniles. The results show that some elements of the code work are applicable in this space, but clear differences also emerge. These findings affect the generalizability of the approach and the understanding of street violence.
Frühpädagogische Fachkräfte sind vor dem Hintergrund der gesellschaftlichen Entwicklungen ein bedeutender Faktor bei der Herstellung und Beibehaltung von sozialem Frieden und gesellschaftlichem Zusammenhalt in Deutschland. Um die integrative Funktion ernst zu nehmen, braucht es Demokratieerziehung von Anfang an und Fachkräfte benötigen zeitliche Ressourcen für die Zusammenarbeit mit Familien und zur Selbstreflexion. Hier sind Träger und Politik gefragt, geeignete Rahmenbedingungen zu schaffen.
In einvernehmlich nicht monogamen Beziehungen (ENMB) sind Menschen mit mehr als einer Person in einer (sexuellen und/oder emotionalen) Intimbeziehung verbunden. Vermehrt nehmen Personen, die in ENMB leben (wollen), psychosoziale Angebote in Anspruch. Damit Berater*innen angemessen auf deren Beratungsanliegen reagieren können, werden konkrete Empfehlungen für die therapeutische Arbeit formuliert. Die Empfehlungen basieren auf veröffentlichten Fallstudien, die bisher fast ausschließlich in englischer Sprache vorliegen, sowie der Beratungspraxis des Autors. Dadurch soll ein Beitrag zu einer besseren psychosozialen Versorgung von Menschen geleistet werden, die einvernehmlich nicht monogam leben (wollen).
Anhand einer qualitativen Interviewstudie mit älteren Menschen zum Thema Tod und Sterben sind forschungspraktische Herausforderungen im Umgang mit den Themen Einverständnis, Anonymität und Verschwiegenheit aufgetreten. Diese Herausforderung betrifft dabei nicht nur vulnerable Interviewpartner, jedoch stellt sich bei dieser Personengruppe die Frage nach einem besonderen Schutz aus forschungsethischer Perspektive. Auf Basis dieser eigenen empirischen Erfahrung ist folgende forschungspraktische Frage der Erfüllung und Dokumentation von datenschutzrechtlichen Bestimmungen aufgekommen: Kann eine informierte Einwilligung anstelle der Schriftform auch auf Tonband gegeben werden?
Vor diesem Hintergrund beschäftigt sich der Beitrag mit Möglichkeiten, wie datenschutzrechtliche Bestimmungen und deren Dokumentation erfüllt werden können, ohne dass sich dieser Prozess negativ auf eine (notwendige) Vertrauensbildung im Rahmen der Interviewsituation auswirkt. Der Beitrag diskutiert hierzu den Vorschlag, das Einverständnis und deren Dokumentation nicht schriftlich, sondern in Form einer verbalen Aufzeichnung durchzuführen. Hierzu werden sowohl forschungsethische als auch datenschutzrechtliche Aspekte aufgegriffen und eingeordnet. Aus der Diskussion werden schließlich konkrete und praxisorientierte Hinweise für Forschende abgeleitet.
Der vorliegende Artikel stellt Nähe und Distanz als Gestaltungsmöglichkeiten der Beratungsbeziehung im
Kontext psychosozialer Beratung dar. Auf Grundlage empirischer Daten einer qualitativen, videogestützten
Grounded-Theory-Studie wird die Perspektive der Adressat_innen von Beratung fokussiert. Hierbei werden
anhand von Aussagen der Befragten insbesondere die Aspekte Material- und Methodeneinsatz sowie das
beraterische Vorgehen in Bezug auf das Spannungsfeld Nähe und Distanz dargestellt. Abschließend werden
Schlussfolgerungen für eine gelingende Nähe-Distanz-Gestaltung für die beraterische Praxis abgeleitet.
Aktuell wird die Digitalisierung als Megatrend des Wandels der Arbeitswelt thematisiert. Dabei greift der alleinige Fokus auf die Digitalisierung als Treiber und Auslöser aktueller Veränderungen zu kurz. Gerade im öffentlichen Sektor sind die Triebkräfte der anhaltenden Reorganisation in der Einführung des New Public Management (NPM) sowie der Sozial- und Gesundheitsreformen zu sehen. Versteht man diese Entwicklungen als Teil eines soziohistorischen Prozesses der Informatisierung, zeigt sich, dass die Diskussion um Digitalisierung der sozialen Arbeit neue Schlaglichter auf eine bekannte Debatte wirft, nämlich auf Tendenzen der Ökonomisierung, Bürokratisierung und Standardisierung von Arbeit. Der vorliegende Beitrag nimmt Bezug auf diese Entwicklungen und fragt danach, wie Führungskräfte in der sozialen Arbeit ihre Arbeit wahrnehmen, inwieweit sie Prozesse der Informatisierung und Digitalisierung als Chance oder Risiko sehen. In der Empirie zeigt sich, dass aus Sicht der Beschäftigten die Arbeits- und Beschäftigungsbedingungen im Feld der sozialen Arbeit weniger von Digitalisierung als von Informatisierung geprägt sind. Erfahren werden die Veränderungen primär als Belastungszunahme und Bedrohung für das professionelle Selbstverständnis.
Von der Arbeit 4.0 zum Sinn 4.0? Über das Sinnerleben in der Arbeit in Zeiten der Digitalisierung
(2020)
Die digitale Transformation verändert die Arbeitsgestaltung sowie das Arbeitserleben von Beschäftigten substanziell mit weitreichenden Konsequenzen für das gesellschaftliche Verständnis von Arbeit, aber auch für die Arbeitsansprüche von Beschäftigten. Vielfach werden in der aktuellen Debatte über die Digitalisierung Folgen für den Sinn von Arbeit oder das Sinnerleben von Beschäftigten angesprochen, ohne dass sich ein eindeutiges Bild ableiten lässt. Der Beitrag zielt darauf, die Auswirkungen der digitalen Transformation auf den Sinn von Arbeit wie auch auf das Erleben von Sinn im Bereich der Arbeit auszuloten. Dazu wird eine Heuristik genutzt, die verschiedene Diskursstränge über Sinn und Arbeit differenziert und den Stand der unterschiedlichen Debatten rekonstruiert. Der Beitrag zeigt die Unterschiedlichkeit der Debatten und die heterogenen Vertiefungsgrade der Diskussionen. Weiterhin kann gezeigt werden, dass weniger die digitale Arbeit bzw. Effekte der Digitalisierung selbst, sondern vielmehr die Veränderungen von Handlungsspielräumen Konsequenzen für das Sinnerleben haben, welche auf die betriebliche Leistungspolitik zurückzuführen sind.
In den zurückliegenden 20 Jahren hat der Gesetzgeber eine Reihe von Gesetzen zum Kinderschutz novelliert oder neu geschaffen. Im Zentrum stand dabei der Versuch, den Schutz von Kindern und Jugendlichen vor Gefahren nachhaltig zu verbessern. Dabei ging es immer wieder auch um das Zusammenwirken von Jugendämtern und Familiengerichten. Zudem wurde der Aufgabenbereich der Verfahrensbeistandschaft als weiterer Akteur in Kindeswohlverfahren neu geschaffen und gesetzlich eindeutiger fixiert. Diese Veränderungen und ihre Auswirkungen wurden im Zeitraum von 2014 bis 2016 im Rahmen eines bundesweiten Praxisforschungsprojektes zum „Kindeswohl zwischen Jugendhilfe und Justiz“ untersucht und analysiert. Der hier vorgelegte Beitrag beschäftigt sich auf der Grundlage der Ergebnisse aus diesem Projekt mit eben diesem Zusammenwirken der oben genannten Akteure im Kinderschutz.
Der Beitrag diskutiert anhand des Forschungsprojektes Game Based Learning in Nursing – Spielerisch Lernen in authentischen, digitalen Pflegesimulationen (GaBaLEARN)
die Einbindung von Learning Analytics in digitale Fallsimulationen eines Serious Games. Es werden pflege- und mediendidaktische Impulse zur Entwicklung und Integration von Learning Analytics für die Darstellung von situativen, komplexen Kompetenzen im Bereich personenbezogener Dienstleistungsberufe, wie der Pflege, dargestellt.
Aktuelle wissenschaftliche Auseinandersetzungen mit dem Sinnerleben Beschäftigter thematisieren vor allem die Problematik eines belastungsbedingten Sinnverlustes. Danach leiden immer mehr Beschäftigte darunter, ihre Arbeit nicht mehr als sinnvoll empfinden zu können. Eine solche Perspektive lässt allerdings die subjektiven Gestaltungsleistungen und Aneignungsformen von Arbeit aus dem Blick geraten. Diesen wendet sich der Beitrag zu, indem er danach fragt, inwieweit sich unterschiedliche Formen der Aneignung von Arbeit identifizieren lassen. Auf der Basis von Interviews mit vierzig hochqualifizierten Beschäftigten werden drei unterschiedliche Aneignungsmodi mit ihren inhärenten Ambivalenzen identifiziert. Jeder Modus steht für eine spezifische Sichtweise auf die eigenen Gestaltungsmöglichkeiten und für eine Form der primären Sinnzuschreibung in der Arbeit. Differenziert werden drei Idealtypen – „progressive Sinngestaltung“, „widerständige Sinnbewahrung“ sowie „pragmatische Sinnbewahrung“ –, anhand derer die Heterogenität und die Ambivalenzen der Aneignung professioneller Arbeit deutlich werden. Der Beitrag liefert so Erkenntnisse über die subjektiven Praktiken des Bedeutsam-Machens von Arbeit und trägt zur Erforschung des Zusammenspiels von Arbeit und Subjektivität bei.
Mental Stress and Health-Related Quality of Life in Adolescents with Gender Dysphoria Although the level of mental stress in adolescents with gender dysphoria is found to be generally high in many studies, differences have been shown between samples of gender dysphoria clinics for adolescents in different countries. However, a comparison within the German speaking area is lacking. In this article we compared samples of gender dysphoria clinics from Munster (Germany) and Zurich (Switzerland) and tested potential correlates of mental stress using quantitative methods. Subsequently, we interviewed clients from both clinics regarding mental stressors and protective factors. There were no quantitative differences in the level of mental stress of clients between Munster and Zurich, whereas health-related quality of life was significantly higher in Munster. Problems in physical well-being and school environment were the strongest correlates of mental stress. This reflects in the interviews, too, in addition to further related factors reported. We conclude that physical well-being and inclusion at school should be addressed with special emphasis in counseling or treatment of adolescents with gender dysphoria to counter the in average high levels of mental stress. Zusammenfassung Das Ausmaß psychischer Auffälligkeiten bei Jugendlichen mit Geschlechtsdysphorie wird in vielen Studien als hoch beschrieben, unterscheidet sich jedoch in den Inanspruchnahmepopulationen verschiedener Spezialambulanzen für Jugendliche mit Geschlechtsdysphorie. Bislang hat kein Vergleich innerhalb des deutschsprachigen Raums stattgefunden. In diesem Beitrag werden die Inanspruchnahmestichproben der Spezialzentren in Münster und Zürich mit quantitativen Methoden verglichen sowie Korrelate von psychischen Auffälligkeiten geprüft. Anschließend führten wir Interviews mit Klient/innen1 der Spezialambulanzen hinsichtlich psychischer Belastungen und Schutzfaktoren durch. Es zeigten sich im quantitativen Vergleich der Zentren keine Unterschiede in den psychischen Auffälligkeiten zwischen Münster und Zürich, während sich die gesundheitsbezogene Lebensqualität in Münster als signifikant höher erwies als in Zürich. Als stärkste Korrelate psychischer Belastung konnten Probleme im körperlichen Wohlbefinden sowie im schulischen Umfeld identifiziert werden. Dies spiegelte sich auch in den qualitativen Interviews wider, in denen weitere assoziierte Faktoren benannt wurden. Wir schlussfolgern, dass das körperliche Wohlbefinden und die schulische Integration in der Beratung bzw. Behandlung von Jugendlichen mit Geschlechtsdysphorie besonders berücksichtigt werden sollten, um der im Schnitt hohen psychischen Auffälligkeiten entgegenzuwirken.
Formulating transference in cognitive and dynamic psychotherapies using role relationship models
(2009)
Configurational analysis, a system that can be used to organize formulations of transference phenomena, may be helpful to cognitive behavioral as well as psychodynamic therapists. We interviewed 41 experienced psychotherapists, 24 of whom were psychodynamic therapists and 17 of whom were cognitive-behavioral therapists. The therapists first each rated one of their well-known patients on a list of 12 simple positive and negative transferences. Next, they described the patient's transference in their own words. After that, each therapist formulated the same patient's transference contents according to a more complex format, the Role Relationships Model Configuration (RRMC). Both groups reported relatively similar levels of both positive and negative transference reactions. Both groups found the RRMC format useful, with 38 (92.7%) of the 41 therapists indicating that they found the RRMC method “moderately” to “very” useful. Using the RRMC as a structured approach to identify and describe transference and relationship patterns appears to be helpful to psychotherapists with different theoretical orientations.
OBJECTIVE Parental cancer increases the risk of psychosocial problems in adolescents. We investigated the frequency and efficacy of adolescents' coping strategies and relationships between those strategies and mental health status. Age and gender differences regarding coping and mental health were also investigated. METHODS In total, 214 adolescents from 167 families participated in a cross-sectional, multicenter study. All participants were recruited from standard oncological care. Among the participants, 52% utilized a child-centered intervention program. Adolescents' coping skills were measured using KIDCOPE. Mental health status was rated by adolescents and parents by the SDQ for symptomatology and the KIDSCREEN for well-being. RESULTS We found that 29% of the adolescents showed emotional and behavioral problems. We found gender differences in mental health status but not in coping. Adolescents used a broad spectrum of coping strategies. Active problem-solving, distraction, acceptance, wishful thinking and seeking social support were the most frequently used coping strategies. The utilization of certain coping skills was mediated by their perceived efficacy. Problem-focused or approach-oriented coping strategies generally are associated with better mental health, while avoidance-oriented coping are associated with worse mental health. Emotion-focused coping was associated with both lower and higher mental health. CONCLUSION The strategies used by adolescents to cope with parental cancer are associated with their mental health. Problem-solving and approach-oriented coping strategies should be facilitated by psychological interventions regardless of age and gender. Age and gender differences in adolescents' mental health should be further investigated because these differences are not explained by differences in coping strategies.
Parental cancer: factors associated with children's psychosocial adjustment - a systematic review
(2012)
OBJECTIVE Children of cancer patients have an increased risk of developing psychosocial problems. But not all children are alike vulnerable to this stressful event. Thus, knowledge of risk and protective factors is required to design specific diagnostic tools and interventions for this vulnerable population. This study aims to provide a review and methodological evaluation of current studies examining factors associated with children's psychosocial adjustment when a parent has cancer. METHODS Four databases were systematically searched for quantitative research articles examining associative factors of children's adjustment. Study characteristics were analyzed and methodological quality was assessed by two independent reviewers. RESULTS 28 studies examining associative factors in 2896 families were identified. The included studies used a broad range of instruments assessing children's adjustment. Most patients were female breast cancer patients with middle to high socio-economic status. The majority of included studies used correlational approaches and cross-sectional designs. None of the studies examined toddlers or assessed children's quality of life. Across studies with low to high quality, we found no evidence of illness-related factors, except worse disease status that was related to lower adjustment. Evidence from moderate to high quality studies suggest that better family functioning indicates better adjustment, whereas parent's depressive mood indicates worse adjustment of the children. Child-related factors were inconsistent. CONCLUSION Health professionals should pay attention to cancer patients' dependent children. In order to identify this at-risk population, parent's depressive mood and poor family functioning should be considered. Future studies should also assess children's quality of life and child-related factors.
The Use of Interpreters in the Work with Refugee Children, Adolescents, their Families and Key Persons in Psychotherapeutic Care System Psychotherapy with interpreters is demanding and poses specific challenges to all participants. Simultaneously it can generate resources which are beneficial to the …
Background Aim of the study was to analyze parenting concerns in cancer survivors and to identify covariats for parenting concerns. Method In a cross-sectional epidemiological sample of cancer survivors with minor children (n=1416) demographic and disease-related variables and psychological distress (HADS) were assessed. Parenting concerns were assessed using the Parenting Concerns Questionnaire (PCQ). The instrument covers the 3 subscales concerns about the 'practical impact' of the disease on the children, about the 'emotional impact' and concerns about the 'co-parent'. Results 73% of survivors were female; mean age was 47.5 years (SD 5.9). 24% to 71% of patients reporting parenting concerns showed normal levels of anxiety and depression. We identified living alone, younger age of the youngest child, higher tumor stage and suffering from a comorbidity as significantly associated with parenting concerns in all subscales of the PCQ. Low socio-economic status was found to be significantly associated with parenting concerns regarding the emotional and practical impact of the disease. Being a mother was associated with concerns in the subscale co-parent. Discussion Parents with cancer not only suffer from psychological distress but also from parenting concerns about the impact of their disease on their children. Psychological support services should broach the issue of parenting concerns. Families at risk should be identified to allocate tailored support. Hintergrund Ziel der dargestellten Untersuchung ist es, elterliche Sorgen von Krebsüberlebenden zu untersuchen und Kovariaten dieser spezifischen Belastungen zu identifizieren. Material & Methoden In einer epidemiologischen Stichprobe von n=1416 an Krebs erkrankten Eltern wurden soziodemografische und medizinische Merkmale sowie die psychische Belastung der Eltern (HADS) erhoben. Elterliche Sorgen wurden mit dem Parenting Concerns Questionnaire (PCQ) erhoben, der die Subskalen Sorgen um die ‚praktischen Auswirkungen‘ der Erkrankung auf die Kinder, ‚emotionale Auswirkungen‘ auf die Kinder und Sorgen in Bezug auf den ‚Co-Elternteil‘ umfasst. Ergebnisse 73% der Krebsüberlebenden sind Frauen, das durchschnittliche Alter liegt bei 47,5 Jahren (SD 5,9). Zwischen 24% und 71% der Patienten mit elterlichen Sorgen zeigen in den Skalen der HADS unauffällige Werte. Alleinleben, jüngeres Alter des jüngsten Kindes, ein höheres Tumorstadium und das Vorhandensein einer weiteren körperlichen Erkrankung sind mit Sorgen in allen 3 Subskalen des PCQ positiv assoziiert. Ein niedriger Sozialstatus konnte als Kovariate für elterliche Sorgen auf emotionaler Ebene und auf praktischer Ebene identifiziert werden. Weibliches Geschlecht ist assoziiert mit Sorgen auf der Subskala Co-Elternteil. Diskussion Betroffene Eltern sind neben der allgemeinen psychischen Belastung durch die Erkrankung auch durch Sorgen um ihre Kinder belastet. Psychologische Unterstützungsangebote für krebskranke Eltern sollten auch spezifische elterliche Sorgen thematisieren. Eltern mit Risikokonstellationen für eine erhöhte Belastung sollten besonders berücksichtigt werden, um bedarfsgerecht Unterstützung anbieten zu können.
OBJECTIVE Parents with cancer are concerned about the impact of their disease on their children. However, parenting concerns and associated factors in cancer survivors have not previously been analyzed. The purpose of this study is to examine parenting concerns and to test a path model for understanding parenting concerns in cancer survivors. METHODS In a cross-sectional study, a total of 1416 parents with cancer (mean age 47.5years, 74% women) having minor or young-adult children were recruited through two cancer registries. Parenting concerns were assessed using the Parenting Concerns Questionnaire. Structural equation modeling (SEM) was used to analyze the associations between social support, parenting confidence, emotional distress, family functioning and parenting concerns. RESULTS Mothers reported higher total parenting concerns than fathers (p<0.001). We observed strong effects of emotional distress and parenting confidence on parenting concerns. Family dysfunctioning was associated with lower concerns. An indirect association between social support and parenting concerns was identified. CONCLUSION Parenting concerns in cancer survivors display the need for interventions and after care programs that focus on affected families with minor and young adult children. The results of the structural path model illustrate the associations between psychological and interactional factors. Supporting parents with cancer in their parenting confidence and strengthen social support and family functioning may not only reduce the long-term burden on the parents themselves but also the burden on the entire family.
OBJECTIVE Although cancer patients with minor children have become more of a focus of psycho-oncological research, little is known about specific parenting concerns. Instruments to assess the concerns and worries of parents with cancer are rare. The Parenting Concerns Questionnaire (PCQ) addresses this issue. We analyzed parenting concerns in cancer survivors and evaluated the German version of the PCQ. METHODS A total of 1416 cancer survivors with minor and young adult children (≤21 years) were recruited in a register-based study. Descriptive analyses as well as reliability and validity analyses were conducted. We performed a confirmatory factorial analysis of the factor structure proposed by the authors of the original version on the PCQ. RESULTS Seventy-three percent of the cancer survivors were women, average age was 47.5 years (SD 5.9). Mean time since diagnosis was 44 months (SD 23.4). Between 18 and 31% of survivors reported that they were concerned about their children. The PCQ proved to be a reliable and valid instrument showing medium correlations with standardized measures in expected directions and discriminating between survivors with and without use of psychosocial support services. The factor structure was supported by the confirmatory factorial analysis. CONCLUSIONS Assessing parenting concerns gives an additional insight into the situation of parents with cancer. In our sample of cancer survivors, we identified one out of three survivors being concerned regarding the impact of their illness on their children. The PCQ can be considered as a valid and reliable instrument with regard to identifying concerned parents with cancer. Copyright © 2015 John Wiley & Sons, Ltd.
BACKGROUND Anxiety and depression can be a long-term strain in cancer survivors. Little is known about the emotional situation of cancer survivors who have to deal with work- and family-related issues. The purpose of this study was to investigate anxiety and depression in working-age cancer survivors and associated factors. METHODS A register-based sample of 3370 cancer survivors (25 to 55 years at time of diagnosis) diagnosed up to six years prior to the survey was recruited from two German cancer registries. Demographic and medical characteristics as well as self-reported measures were used. RESULTS Overall, approximately 40% of the survivors reported moderate to high anxiety scores and approximately 20% reported moderate to high depression scores. Compared to the general population, working-age cancer survivors were more anxious but less depressed (p < .001). Subgroups with regard to time since diagnosis did not differ in anxiety or depression. Anxiety and depression in cancer survivors were associated with various variables. Better social support, family functioning and physical health were associated with lower anxiety and depression. CONCLUSIONS Overall, we found higher anxiety levels in cancer survivors of working-age than in the general population. A considerable portion of cancer survivors reported moderate to high levels of anxiety and depression. The results indicate the need for psychosocial screening and psycho-oncological support e.g. in survivorship programs for working-age cancer survivors. Assessing the physical health, social support and family background might help to identify survivors at risk for higher emotional distress.
BACKGROUND Cancer patients and their minor children have been shown to experience psychological distress. The objectives of the current study were to 1) describe the need for and use of psychosocial support and 2) determine predictors of family-centered support use in patients with minor children. METHODS A population-based sample of 1809 patients was recruited via 2 cancer registries. The eligibility criteria were age 25 years to 55 years, an initial diagnosis received no longer than 6 years before this survey, and having at least 1 minor child. Medical characteristics and self-report measures were used. RESULTS Overall, approximately 38% cases were identified as being borderline or probable anxiety cases and 16% were identified as being borderline or probable depression cases. Since diagnosis, 44% of the patients had used psychosocial support and 9% had received family-focused and child-focused support. These patients perceived a lower quality of life and poorer family functioning. Approximately 73% of patients with children wanted information concerning or psychosocial services to support their children or parenting. Use of family-centered support was not found to be predicted by disease-related factors (eg, cancer staging) but rather by subjective needs (eg, mental health and having a distressed child in the family). CONCLUSIONS The results of the current study emphasize the importance of child and parenting concerns in psychosocial care in oncology. Screenings for children and appropriate training programs for health care may increase awareness of this issue.
Approximately 300,000 asylum-seeking children arrived in Europe in 2015. The chance of experiencing a traumatic event is very high for fleeing children. Since the origin of the refugees is widespread, the languages spoken are diverse. Multilingual electronic patient-reported outcome systems (ePROs) can be used to gather medical data in a foreign language and display the results in the health professionals' language, which helps overcoming the language barrier. Utilizing such a system, a two-phase study aiming to screen refugee minors for potential mental health issues has started. Potential eligible participants are examined using questionnaires with good psychometric properties and cross-cultural applicability. To date, 75 minors and 21 of their relatives participated in the study, being German and Arabic the most desired languages for the electronic survey. Developing a system that provides multilingual questionnaires entails several drawbacks like a cumbersome translation process and dealing with writing directions. The proposed translation process and the ePRO can be re-used in similar studies.
Children of a parent having cancer are at greater risk to develop mental health problems. Aim is to investigate specific psychosocial care for children having a parent with cancer, as well as to characterize and assess utilization and needs of affected minor children. Employees of institutions in Germany supplying psychosocial care to families with a parent having cancer were surveyed, using a semi-structured interview (n = 29). Specific psychosocial care for affected children is limited and heterogeneous in Germany. Regarding different distress stages of those families, the situation could be interpreted as eligible. However, this primarily reflects the low quality assurance of care. Results suggest that in addition to preventive care needs of children having a parent with cancer, increased needs exist in specific risk constellations, like in single parent families.
OBJECTIVES Children of cancer patients have an increased risk for developing emotional problems. While psychosocial cancer counselling services are available all over the country, it is unclear if parents seek for help and if specific approaches for families are offered. METHODS A survey was made of outpatient cancer counselling services in Germany (n=228). The response rate was 56%. Descriptive and content analyses of the data have been used. RESULTS Providers estimate that 55% of their patients are between 18 and 55 years with 18% of them having minor children. However, only 53% do regularly ask their patients if they have minor children. Family- or child-settings are not provided regularly. Over 60% of providers would welcome special courses on this subject. CONCLUSION Although psychosocial care of minor children is mentioned in outpatient psychosocial cancer counselling guidelines, children are not included regularly. A stronger emphasis on this topic in further education has to be made.
The presence of cancer and additional parental responsibilities can increase strain for individual patients as well as for their children. The construct of health-related quality of life (HRQL) is appropriate to measure a combination of physical, mental and social consequences as a result of disease. However, previous research has merely focused on symptom checklists. This study addresses the following questions: (i) does HRQL in children and their parents with cancer differ compared to the general population? (ii) Are there any variables that are associated with HRQL in children? (iii) What are current psychosocial support needs? A population-based survey of 976 survivors (<6 years post diagnosis) with minor children between 6 and 18 years (n = 1,449) was conducted with two German cancer registries. HRQL was assessed using SF-8 (survivors) and Kidscreen (children). The results were compared to normative populations, and predictors associated with HRQL in children were evaluated within a multilevel model. We found that the HRQL in children was better compared to the norm. Only children with support needs had worse HRQL. Older age, having a mother with cancer, having a parent not living together with a partner, and worse parental physical and mental health influenced HRQL in children. Illness characteristics were irrelevant. Even with a mean of 3.5 years after diagnosis, survivors had lower physical and mental health compared to the norm. Our findings reinforce the need for health professionals to pay attention to younger patients and their children. Even years after diagnosis, life might not have returned to normal.
Children of cancer patients are at risk for developing psychological symptoms. The parental appraisal of the child's psychological condition is a key variable for the utilization of child-centred psychosocial services. This study aimed at the systematic analysis of parental appraisals of changes in the emotional condition or behaviour of their children. We conducted an epidemiologic survey with a sample size of 1,809 patients with different cancer diagnoses, giving information about 2,581 children aged 21 years or younger at time of diagnosis. Quantitative information on children's distress during the disease and on changes in psychological condition or behaviour and qualitative information on the kind of changes were analysed. About half of the children were considered to be psychologically strongly affected during the disease. For about 25 % negative changes in psychological condition or behaviour are reported, positive changes are reported for 20 % of the children. Negative changes are most frequently described in young children (up to five years), positive changes are most frequently described in young adults (18 to 21 years). The results indicate that from the cancer parent's view many children are substantially distressed. Thus, the implementation of additional preventive psychosocial services seems reasonable and necessary.
OBJECTIVE The concept of family functioning is gaining importance in psycho-oncology research and health care services. The Family Assessment Device (FAD) is a well-established measure of family functioning. Psychometric properties inherent in the German 51-item adaptation of the FAD are examined in different samples of families with parental cancer. METHODS Acceptance, reliability, and validity of FAD scales are analysed in samples from different study settings (N=1701 cancer patients, N=261 partners, N=158 dependent adolescent children 11 to 18years old). RESULTS Missing items in the FAD scales (acceptance) are rare for adults (<1.1%) and adolescent children (<4.4%). In samples of adults and older adolescents (15 to 18years), all FAD scales except for the Roles scale are significantly reliable (0.75≤Cronbach's α≤0.88). The scales correlate highly (0.46≤Pearson's r≤0.59) with the criterion satisfaction with family life (convergent validity), and have smaller correlations (0.16≤r≤0.49) with measures of emotional distress and subjective well-being (divergent validity). In most FAD scales, adults seeking family counselling report worse family functioning (0.24≤Cohen's d≤0.59) than adults in other samples with parental cancer (discriminative validity). CONCLUSION Overall, the German 51-item adaptation of the FAD reveals good acceptance, reliability, and validity for cancer patients and their relatives. Particularly the scale General Functioning shows excellent psychometric properties. The FAD is suitable in the assessment of families with parental cancer for adults and adolescents older than 11years.
Children exposed to parental cancer have an increased risk of mental health problems. However, the parental illness itself and its features do not predict children's psychological adjustment. Parent- and family-related factors are more predictive for children's well-being and the incidence of psychopathological symptoms, respectively. This study focuses on parental ways of coping with illness from both, the ill and healthy parent's perspective, and the relationship with family functioning and children's adjustment. Results show a significant impact of parental coping styles on children's health-related quality of life and psychopathological symptoms and, furthermore, that this relationship is mediated by aspects of family functioning. This study support the importance of family systems approaches. Implications for further studies and practical issues are discussed.
OBJECTIVE To compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life. METHODS A total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered. RESULTS Half of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents. CONCLUSION Family members confronted with parental cancer or mental disorders are more burdened compared with those from the normal population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment.
If One Feels Better Like That …. Adolescent Sibling Relationship in the Context of Transgender Development A transgender development in youth can influence the relationship of concerned youth and their siblings. While in most surveys, the focus lies on transgender adolescents, both sides shall be interviewed here to capture the situation of siblings and to relate the results. For this purpose, guide interviews with ten transgender adolescents and twelve of their siblings were analysed in accordance to Grounded Theory. In most cases, participants were satisfied with the sibling relationship. After the coming-out of the transgender adolescent they showed both positive and negative reactions that, however, changed to respect and acceptance by time without exception. Doubt, compassion and grief were short lived and often replaced by joy for the transgender adolescent. Transgender youth were mostly satisfied with the reaction of their sibling though the amount of support varied. The time of coming-out and transition often led to an improvement in sibling relationship, more closeness and family cohesion. In general, siblings seem to be immediately concerned by transgenderism in adolescence. In clinical practice, they should thus be included from the beginning. By taking into account their situation, negative developments can be prevented, and the sibling relationship become usable as a resource. Zusammenfassung Eine transidente Entwicklung im Jugendalter kann die Beziehung der Betroffenen und ihrer Geschwister beeinflussen. Während in den meisten Untersuchungen der Fokus eher auf den transidenten Jugendlichen liegt, wurden hier beide Seiten befragt, um die Situation der Geschwister zu erfassen und die Ergebnisse zueinander in Beziehung setzen zu können. Hierzu wurden Leitfaden-gestützte Interviews mit zehn transidenten Jugendlichen sowie zwölf ihrer Geschwister nach den Regeln der Grounded Theory ausgewertet. In den meisten Fällen zeigten sich die Teilnehmenden mit der Geschwisterbeziehung zufrieden. Auf das Coming-out des transidenten Jugendlichen zeigten die Geschwister positive wie negativen Reaktionen, die sich jedoch im Laufe der Zeit ausnahmslos zu Respekt und Akzeptanz wandelten. Zweifel, Mitleid und Trauer waren nur von kurzer Dauer und wurden oft durch Freude für den transidenten Adoleszenten ersetzt. Die transidenten Jugendlichen zeigten sich mit der Reaktion des Geschwisters grundsätzlich zufrieden, obwohl das Maß an Unterstützung unterschiedlich war. Die Zeit des Coming-out und der Transition führte häufig zu einer Verbesserung der Geschwisterbeziehung, mehr Nähe und familiärem Zusammenhalt. Insgesamt zeigte sich, dass die Geschwister bei einer Transidentität im Jugendalter unmittelbar mitbetroffen sind und daher im klinischen Alltag von Anfang an mit einbezogen werden sollten. Durch Berücksichtigung ihrer Situation kann negativen Entwicklungen vorgebeugt und die Geschwisterbeziehung als Ressource nutzbar werden.
OBJECTIVE Parental physical disease is a family issue, but families' minor children are seldom considered. The current study analyzed experiences with implementation of counseling for families with physically ill parents and minor children during a European multisite pilot project. METHOD Implementation protocols of seven European partner centers collaborating in a joint research project were analyzed by Mayring's qualitative content analysis. Both an inductive approach and a deductive approach were chosen. Satisfaction of families and therapists was considered based on information from three partner centers. RESULTS Satisfaction with counseling was rather high. Mentioned problems referred to aspects related to liaison partners, family-related aspects and physicians' concerns. Recommendations related to contacting families, liaising with other professions, implementing counseling together with a research project, and training. Results are integrated in the current dissemination literature. CONCLUSION Successful implementation was mostly determined by aspects of interdisciplinary cooperation and communication, perceived relative advantage and organizational premises. With regard to this kind of innovative child-centered family mental health services, top-down and bottom-up implementation strategies should be combined, and strategies of maintenance and sustainability should be considered from the very beginning.
The paper presents some reflections on the transgenerational transmission of traumatic experiences of war and in particular bombing during Second World War. These theoretical considerations are based on a case study (family interview) deriving from the research project Kriegskindheit im Hamburger Feuersturm additionally illustrated and complemented with impressions based on interviews with three generations in context of the project.
The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).
In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, and gain of knowledge through research. After finishing a thorough interdisciplinary assessment an individualized, case-by-case treatment starts. Besides psychotherapy an interdisciplinary treatment (e. g. puberty suppression and cross-sex hormones) is provided if indicated. During childhood a watchful waiting and carefully observing attitude is necessary. If a marked increase of gender dysphoria occurs during the first phases of puberty development, puberty suppression and later cross sex-hormones might be indicated.
Air strikes on Hamburg in 1943 (Operation Gomorrha) were a historical turning point and had a deep impact on both cityscape and history of Hamburg. Little is known about intraindividual and transgenerational consequences as well as its interaction with societal and historical processes. Aiming at closing this gap interviews with witnesses, their children and grandchildren, as well as the whole family, were conducted in the context of an interdisciplinary research project. Based on the example of an interview with a at the time of the Operation Gomorrha eleven years old witness, her daughter, and grandson the biographical localisation of war experiences and transgenerational transmission will be explained and discussed.
BACKGROUND Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project. METHODS A cross-sectional sample of N = 235 families was recruited simultaneously in 5 university medical centers. The participants, including parents (N = 402) and children (N = 324; ages 11-21 years) completed standardized questionnaires. Emotional and behavioral problems in children were measured by the Strengths and Difficulties Questionnaire (SDQ). On the basis of previous research and using a mixed-model approach, child-, parent-, family- and cancer-related variables were examined in addition to socioeconomic status as potential predictors. Descriptive statistics and a multiple random coefficient model were used in the analyses. RESULTS Compared to norms, Children of cancer patients show increased mean levels of emotional and behavioral symptoms. The best predictor of emotional and behavioral problems from the perspectives of the child, the healthy parent, and the ill parent was general family dysfunction. Although family dysfunction was identified as the main predictor, the analysis revealed that the main part of variance was related to the individual child's level. CONCLUSIONS The results indicate that screening for child mental health problems and family dysfunction in oncological and psychosocial treatment units can identify the families most in need of psychosocial support. Psychological services need to be both family-oriented and child-centered and focus on family dysfunction to prevent mental health problems in children.
Irrespective of their well-known increased risk for mental health problems, children of somatically ill parents are a clinically underserved as well as under-researched group. In this article, the authors introduce the epidemiologic and clinical relevance of this topic and present a theoretical framework for understanding the sequelae of a serious parental illness on minor-age children, based on family dynamics and developmental concepts. This is followed by a comprehensive review of current empirical studies in this field, with a special emphasis on results from a transnational European collaborative study (COSIP = Children of Somatically Ill Parents), which was coordinated by the last author. The most important recommendations from intervention concepts published to date are summarized. Some outlooks for clinical practice as well as future research are presented.