Providing better support for children and young people with abnormalities, problems and stress This is the aim of a pilot project in Hamburg. Researchers from Oldenburg are carrying out the evaluation.
Nine-year-old Benny is a child with many endearing qualities - and at the same time an imposition on those around her. Time and again she goes berserk, gets into fights and runs away. Nobody can cope with her: her mother is overwhelmed, Benny is suspended from school. And she has already been kicked out of several residential groups because of her outbursts of rage. This is the initial situation in the multi-award-winning film "Systemsprenger", which not only tells the story of a difficult girl, but also highlights the helplessness of the various institutions in dealing with conspicuous children - despite the best intentions of everyone involved.
"In Germany, it is difficult to provide appropriate care for children and young people who exhibit challenging behaviour or mental health problems - partly for structural reasons," says Prof. Dr Karsten Speck. The Oldenburg education researcher is involved in a pilot project with a new approach: In the DreiFürEins project, schools, youth welfare services and child and adolescent psychiatry work closely together. This "multi-professional co-operation" is intended to help identify children and young people who, like Benny, need support at an early stage and provide them with more targeted support.
Speck and his team are responsible for the scientific evaluation of the project, which is based in Hamburg and led by the Techniker Krankenkasse (TK) health insurance company. Together with his colleagues Dr Anja Schäfer and Nantke Schmidt, he is investigating whether the new approaches actually help to improve children's quality of life and reduce behavioural problems. A team from the University of Erlangen-Nuremberg is also investigating whether the new treatment saves costs as hoped. Other project partners are the health insurance companies AOK Rheinland/Hamburg, DAK-Gesundheit, IKK classic, KNAPPSCHAFT and BARMER, the Asklepios Klinikum Hamburg-Harburg and the Katholisches Kinderkrankenhaus Wilhelmstift. DreiFürEins is being subsidised over four years with up to 5.9 million euros from the innovation fund of the Federal Joint Committee (G-BA).
Finding conspicuous children at an early stage
The starting point of the project, which began in spring 2021, is early screening of children and young people with mental or emotional problems. "We assume that a considerable proportion of all girls and boys are conspicuous," says Schäfer. According to studies, the proportion in Germany is between six and thirty per cent. In order to identify children with particular problems, the Oldenburg team works together with the so-called Regional Education and Counselling Centres (ReBBZ). There are a total of 13 of these centres in various districts of Hamburg. They are a point of contact for children and parents in difficulty, but also offer lessons for pupils with special educational needs. Four ReBBZs form the intervention group, in which new care methods are trialled, while the others serve as a control group.
All children and young people between the ages of 4 and 17 who receive long-term counselling at a ReBBZ are to take part in the screening. The questions focus on learning motivation, helpfulness, truancy, tantrums and hyperactivity. If it becomes apparent that a child from one of the four centres in the intervention group needs further help, specialists from schools, youth welfare services and child and adolescent psychiatry work together.
They work on cases together and consider how to proceed in case conferences, for example: Does the family need support with parenting? Should the child receive special educational support or does it need therapy? Cooperation between the specialists is also strengthened through supervision, cross-case teams and further training. "Maybe it's sometimes small things that change as a result of this co-operation, but my hope is that it will pay off for the children and young people in the medium to long term," says Speck.
The services - such as office hours for child and adolescent psychiatry - should be as low-threshold as possible and take place on site at the ReBBZ. In this way, the project team hopes to reach children and young people who have so far fallen through the cracks. Children who are particularly vulnerable should also receive outpatient care and be able to stay with their families.
Stressed professionals
In addition to better care for the children, the project is also focussing on the professionals involved. They are often under a lot of stress and have a high risk of burnout. The Oldenburg team interviews teachers, social pedagogues and child psychologists twice during the project progression to find out how well the co-operation is working and whether self-efficacy is increasing.
Cooperation between schools, youth welfare services and child and adolescent psychiatry is not yet a matter of course - and by no means without hurdles, emphasises Speck: "The expectations are often very high, but in previous projects, the actual implementation has usually proven to be challenging." The reasons for this are different legal systems, organisational structures, technical terms and concepts of human nature. In several studies on co-operation between different professional cultures and institutions, Speck has identified several factors that nevertheless favour cooperation: These include support from managers, fixed time budgets for communication, suitable premises and sufficient financial resources.
These framework conditions are in place at DreiFürEins: therapy rooms are available, as are sufficient specialist staff, so that up to 550 girls and boys can receive therapeutic services by the end of the trial phase in spring 2024. Screening is in full swing and the first children are already receiving the right support. "If the concept proves to be viable, it will be made permanent and, ideally, become a regular programme," says Speck. "Then our project could set a precedent nationwide."
