Freiheitsentziehende Maßnahmen in bayerischen Heimeinrichtungen                     für Kinder, Jugendliche und junge Volljährige mit                     Intelligenzminderung

Geißler, Julia; Werner, E.; Dworschak, Wolfgang; Romanos, Marcel; Ratz, Christoph

doi:10.1024/1422-4917/a000808

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Challenging behaviour, especially aggressive behaviour, is one of the major issues both professional and family caregivers of people with IDD face, bringing with it a heightened risk to mental health and quality of life (8)(9)(10)(11)(12). We recently reported that challenging behaviour is linked to the use of coercive measures (cM) (13). Assuming a direct causal relation, the use of coercive measures may be avoided if the underlying causes of the challenging behaviour were addressedeither by treating relevant psychiatric disorders or by shaping the environment and providing the children with alternative strategies to get their needs met.…”

Section: Introductionmentioning

confidence: 99%

German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities

Geißler¹,

Werner

Dworschak

et al. 2021

Front. Psychiatry

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Background: Approximately 10% of children, adolescents and young adults with an intellectual and developmental disability (IDD) in Bavaria live in residential institutions. 2015 saw media reports raising suspicions about excessive use of coercive measures (cM) in those institutions. Until a law reform at the end of 2017 made permission from family courts mandatory for cM, their use was governed by parental consent. The REDUGIA project conducted a representative survey comparing cM and their relation to challenging behaviour (cB) and employee stress in Bavaria pre and post reform.Methods: We sent questionnaires to 65 residential institutions for children, adolescents and young adults with IDD in 2017 (pre reform, T1) and 2019 (post reform, T2). To assess changes, we analysed data from all available questionnaire pairs (T1 and T2, N = 43). We calculated paired t-test and correlative analyses concerning the relationship between cB, cM, and employee stress.Results: The number of residents overall (T1: N = 1,661; T2: N = 1,673) and per institution (T1: m = 38.6 ± 32.0; T2: m = 38.9 ± 34.5, p = 0.920) remained stable. We did not see any changes in the Index cB (p = 0.508) or the proportion of residents per institution displaying various types of challenging behaviour (all ps>0.220). There was no change in the Index cM (p = 0.089) or any indicator of employee stress, all ps > 0.323. At follow-up, the Index cB correlated positively with the Index cM (r = 0.519 p < 0.001). Regarding employee stress, the Index cB correlated positively with the frequency of sick leave (r = 0.322, p = 0.037) and physical attacks on employees (r = 0.552, p < 0.001). The Index cM also correlated positively with the frequency of sick leave (r = 0.340, p = 0.028) and physical attacks on employees (r = 0.492, p = 0.001).Discussion: Coercive measures are not a general phenomenon, but are focused on specialised institutions. The law reform did not lead to changes in the number of children, adolescents and young adults with IDD affected by coercive measures in residential institutions in Bavaria. There were still large discrepancies between institutions in the prevalence of challenging behaviour and coercive measures. Coercive measures were associated with challenging behaviour and employee stress. Taken together, findings from REDUGIA emphasise the need to prevent challenging behaviour and thus coercive measures.

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Section: Introductionmentioning

confidence: 99%

German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities

Geißler¹,

Werner

Dworschak

et al. 2021

Front. Psychiatry

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“…Caregivers of children with ASD and/or IDD experience high levels of stress, especially due to CB. A recent representative survey in residential facilities for young people with IDD in Bavaria, Germany, showed that CB in children and adolescents with IDD is significantly associated with employee stress and the use of coercive measures ( Geissler et al, 2021a ). Giovagnoli and colleagues were able to show that parental stress was less related to the severity of ASD core symptoms and more related to the extent of certain challenging behaviours (emotional reactiveness, aggression) ( Giovagnoli et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Smartphone-based behaviour analysis for challenging behaviour in intellectual and developmental disabilities and autism spectrum disorder – Study protocol for the ProVIA trial

Geißler

Buchholz²,

Meerson³

et al. 2022

Front. Neurosci.

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BackgroundChallenging behaviour (CB) comprises various forms of aggressive and problematic behaviours frequently occurring in children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD). CB often arises from impaired communication or problem solving skills. It is often met with coercive measure due to a lack of alternative strategies on the part of the caregiver, while it also impacts on the caregivers due to the exposure to physical harm and high levels of stress. Within the ProVIA project we developed a smartphone-based tool for caregivers of children with IDD and/or ASD to prevent and modify CB. The ProVIA app systematically helps caregivers to identify specific causes of CB and provides individualised practical guidance to prevent CB and consecutive coercive measures, thus aiming to improve the health and well-being of the children and caregivers.MethodsIn this uncontrolled open trial we will enrol N = 25 caregivers of children aged 3–11 years with a diagnosis of IDD and/or ASD. Participants will use the ProVIA-Kids app for 8 weeks. During the intervention phase, participants will conduct behaviour analyses after each instance of CB. The app will summarise the identified putative causes for the CB in each situation, and provide recommendations regarding the handling and prevention of CB. Furthermore, the app will aggregate data from all available behaviour analyses and identify the most relevant (i.e., most frequently reported) risk factors. Measurement points are at baseline (T0), after the intervention (T1) and 12 weeks after the end of the intervention (follow-up; T2). The primary outcome is the absolute change in parental stress (EBI total scale) between T0 and T1. Further aspects of interest are changes in CB severity and frequency, caregiver mood, satisfaction with the parenting role (EFB-K total scale) and experienced parenting competence (FKE total scale). Pre-post comparisons will be analysed with paired sample t-tests.DiscussionProVIA is pioneering structured behaviour analysis via smartphone, assessing predefined causes of CB and providing feedback and recommendations. If this approach proves successful, the ProVIA-Kids app will be a valuable tool for caregivers to prevent CB and improve their own as well as the children’s quality of life.Trial registrationThe study is registered at https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_IDDRKS00029039 (registered May 31, 2022).

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Legal, clinical and structural aspects of modern intensive care for children and adolescents with mental disorders

Vloet,

Geißler,

Taurines

et al. 2024

Bundesgesundheitsbl

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ZusammenfassungIn den letzten Jahren ist der Anteil der Notfallvorstellungen in den Versorgungsstrukturen für Kinder und Jugendliche kontinuierlich gestiegen. Die akutstationäre geschlossene Behandlung ist ein wesentlicher Baustein der Versorgung und dient vorrangig dem unmittelbaren Schutz von Kindern und Jugendlichen in psychischen Krisensituationen. Die geschlossene Unterbringung unterliegt strengen rechtlichen Voraussetzungen, die 2017 in Form des § 1631b BGB novelliert wurden und seither erstmals zu einer klaren Trennung der Anwendung von freiheitsentziehenden Maßnahmen (FEM) gegenüber der freiheitsentziehenden Unterbringung (FEU) von Kindern und Jugendlichen geführt hat.Anhand der Umgestaltung der Intensiveinheit am Universitätsklinikum Würzburg werden in diesem Artikel beispielhaft die Erfordernisse an eine moderne Akutversorgung von Kindern und Jugendlichen mit psychischen Erkrankungen dargestellt. Infolge der Modernisierung am Universitätsklinikum Würzburg konnte Freiheitsentzug auf ein Minimum reduziert werden – auf aktuell durchschnittlich 1,5 Tage bei etwa 500 Aufnahmen mit FEU im Jahr. Die Gefahr der Hospitalisierung insbesondere bei chronisch suizidalen Patienten besteht praktisch nicht mehr. Durch Kooperation mit anderen Kliniken ist es in der Region seit 2017 gelungen, alle minderjährigen Patienten mit akutstationärem Behandlungsbedarf in kinder- und jugendpsychiatrischen Strukturen zu versorgen. Langfristige geschlossen-stationäre Behandlungen über viele Monate kommen bei chronischer Suizidalität nicht mehr vor.

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Freiheitsentziehende Maßnahmen in bayerischen Heimeinrichtungen für Kinder, Jugendliche und junge Volljährige mit Intelligenzminderung

Cited by 3 publications

References 6 publications

German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities

German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities

Smartphone-based behaviour analysis for challenging behaviour in intellectual and developmental disabilities and autism spectrum disorder – Study protocol for the ProVIA trial

Legal, clinical and structural aspects of modern intensive care for children and adolescents with mental disorders

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