Wirksamkeitsüberprüfung einer kinderpsychiatrischen Eltern-Kind-Station unter klinischen Routinebedingungen

Abstract

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.

Efficacy of a Parent–Child Psychiatric Unit Under Clinical Routine Conditions

Abstract. Owing to the complex interaction between children’s mental health and the family context, parent–child units offer the promising opportunity of deeply involving the family environment in child psychiatric treatment. In clinical practice, parent–child units normally entail increased expenditure and higher costs, thus raising questions about the efficacy and effectiveness of this special form of therapy. The parent–child psychiatric unit in Magdeburg offers diagnostic and treatment blocks for seven children (age range 1½–8 years) and their parents, who accompany their children for the duration of the stay. Admission to the ward can be realized on an in-patient or day-patient basis. The concept includes a multiprofessional treatment setting with an intensive and dynamic focus on the quality of the child–parent relationship and interaction and not solely concentrating on the children’s illness. The aim is to change children’s behavioral problems and significantly reduce parental stress levels. Treatment consists of a 3-week diagnostic phase, after which families are discharged to their home environment followed by a 5-week therapy block, for which the families are readmitted to the ward. The integrative, multimodal treatment concept of this model-like ward with its interdisciplinary team employs different therapeutic elements from depth psychology, systemic, behavioral, behavioral-oriented, and mentalization-based therapy approaches. An interdisciplinary interaction and relation-based technique is used, which includes primarily interventions directed toward a positive change of dysfunctional intrafamilial behavioral and interaction patterns. To investigate treatment effects, children’s symptoms were assessed with the CBCL (Child Behavior Checklist) and symptoms of parental stress with the PSQ (Parental Stress Questionnaire) at three different time points. The study was run under routine clinical conditions in a group pretest–posttest design (diagnostic block, start of therapy, and end of therapy) with a total sample of 60 families. Control variables were the subjectively reported duration of children’s symptoms as well as the waiting period between the diagnostic and therapy phases. During the waiting time between the diagnostic and therapy block, for which the families were discharged to their home environment, no significant effects were observed, as expected. In accordance with the a priori hypothesis, children’s behavioral problems decreased in the course of the parent–child treatment, which is in accordance with previous findings from similar model wards. For the first time, however, a significant change in parental stress experience was demonstrated, showing the greatest effect size compared with changes in children’s behavioral problems. Overall, these results support the currently available research on the efficacy of parent–child treatment approaches and provide important information for the therapeutic efficacy of child psychiatric parent–child units. Furthermore, they underline the findings from existing studies on the close interaction of children’s symptoms and parental stress.