Jörg M. Fegert
Original keynote abstract and slide presentation by Jörg M. Fegert (Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie Universitätsklinikum, Ulm, Germany) on Care of traumatized children in youth welfare systems (ESCAP 2017 Congress in Geneva, Switzerland).
Objective: To give an overview on the prevalence of traumatic experiences and associated psychopathology in children and adolescents living in residential care. Methods: A general overview on the issue of institutionalized children as a high-risk group with multiple traumatic experiences is given. The presentation focusses on two original studies with children in residential care in Switzerland and Germany. A sample of 370 adolescents living in Swiss youth welfare institutions (11 to 18 years old, 66% male) answered the Essen Trauma Inventory and the Youth Self Report (YSR). Three subgroups of trauma types were created: ‘no interpersonal trauma’, ‘single interpersonal trauma’, and ‘multiple interpersonal trauma’ (experiences in at least two domains: sexual abuse, physical abuse, neglect). ANOVAS were conducted with the trauma-type subgroup as a factor and all subscales of YSR as dependent variables. In a second study, a sample of 322 adolescents living in German youth welfare institutions or residential schools (15 to 22 years old, 57% male) answered a questionnaire in regard to lifetime experiences of sexual assault and the YSR. A MANOVA was conducted to compare psychopathology of victims and non-victims.
Results: Of the 370 adolescents of study 1, 80% reported any traumatic event, 27% reported single interpersonal trauma, and 29% reported multiple interpersonal trauma. Adolescents with any interpersonal trauma (single or multiple) scored higher on YSR subscales ‘somatic complaints’, ‘rule-breaking behavior’, and ‘aggressive behavior’ compared to adolescents without any interpersonal trauma. Among the traumatized adolescents, those with multiple trauma reached higher values on YSR subscales ‘somatic complaints’, ‘anxious-depressed’, ‘thought problems’, ‘rule-breaking behavior’, and ‘aggressive behavior’ than those with single trauma. Of the 322 adolescents of study 2, 57% reported any sexual assault, and 25% reported penetration. Victims of any sexual assault scored significantly higher on YSR scales ‘somatic complaints’, ‘anxious-depressed’, and ‘attention problems’.
Conclusions: Traumatic experiences are common in adolescents living in residential settings. Likewise, sexual assaults are frequently reported by the adolescents. Interpersonal trauma appears to substantially affect externalizing and internalizing problems, especially if the trauma occurred in two or more different domains. Experiences of sexual assaults appear to affect internalizing and attention problems in particular. Results indicate that the focus of educational and therapeutic work in youth welfare institutions should be placed on trauma. Trauma sensitive care in institutions is an important approach for the care giving teams in these institutions. Therefore, some results from a Swiss model project on trauma sensitive care will be presented. Perspectives of care leavers, transition and emerging adulthood in this high-risk population will be discussed.