Patienten- und Elternzufriedenheit bei intensiver,klinikvernetzter Zu-Hause-Behandlung

Background

Due to the increasing importance of effective, patient-oriented treatment options for mentally ill children and adolescents, new alternatives to established inpatient and outpatient care in child and adolescent psychiatry have to be found. Intensive cross-sectoral treatment settings may be an alternative but have not yet been evaluated or implemented in routine care.

Aim

The objective of this randomized study was to compare and assess satisfaction with a new model of care within the underlying BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy) study with regular inpatient care (TAU). Patients in BeZuHG received early discharge from inpatient care followed by 3 months of intensive home treatment enhanced by clinical elements.

Material and methods

Youths and parents were asked to fill in a patient satisfaction questionnaire (BesT) at completion of treatment. Participants in the study were evaluated between April 2012 and January 2013.

Results

Neither BeZuHG nor inpatient care was clearly superior. Youths in the control group stated a higher satisfaction with the overall treatment than youths in the BeZuHG group (p?=?0.031), while youths in the BeZuHG group named a significantly higher satisfaction with the home treatment component than with the inpatient component of treatment (p?=?0.007).

Conclusion

Patient satisfaction could be shown for inpatient and BeZuHG treatment at discharge. Data may change at follow-up. A long-term follow-up should be implemented to confirm these results or to allow other conclusions.     

Station?re Psychotherapie und Medien

Background

According to several studies the application of different media in inpatient psychotherapy and psychiatry has proven to be a useful and effective addition to conventional methods of intervention. This study is the first to catalogue the current spread of media in inpatient treatment as well as the evaluations of media-supported interventions by therapists and patients.

Sample and method

In a representative survey conducted in all psychiatric and psychosomatic clinics in North-Rhine/Westphalia (response: 40 psychologists/doctors and 289 patients from 39 clinics) media equipment, usage of media in different areas, evaluation of and satisfaction with the media usage were measured by a questionnaire which was constructed especially for this purpose.

Results

A widespread usage and acceptance of media could only be found in some areas. The study identified large differences in equipment standards and media usage depending on the type of media, the area of usage and the specific clinic.

Conclusion

Recommendations for the further development and optimization of media usage in inpatient psychotherapy are derived from the results of this study.     

Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Intervallbehandlung statt disziplinarischer Entlassung

Background

Conduct disorder is a frequent mental health problem in children and adolescents characterized by high functional impairment and a poor prognosis. Different types of interventions have been established but only few have proven effective. Relevant effect sizes could only be shown for family centred interventions. Inpatient treatment is not the first line treatment even though children, adolescents and their families often present with a query for inpatient admission when outpatient resources are at their limits.

Aim

The effectiveness of a newly developed interval treatment for adolescents with conduct disorder, which focuses on motivation of the adolescent, involvement of the family in the therapy and the avoidance of disciplinary discharge, was evaluated.

Material and methods

A total of 19 adolescents aged between 16 and 18 years with conduct disorder was treated and assessed within the new interval treatment. The key symptoms of conduct disorder, sociodemographic data, psychosocial functioning (children global assessment of functioning scale, CGAS) as well as the severity of impairment of behavior (health of the nation outcome scales for children and adolescents, HoNOSCA) were recorded before treatment (T1). After completion of treatment (T2) the frequency of participation in the three possible treatment intervals, as well as psychosocial functioning and severity of impairment of behavior were documented.

Results

Interval treatment leads to a reduction of disciplinary discharges. Engagement in and motivation for treatment was enhanced. At the end of treatment a significant effect on psychosocial functioning, behavior and severity of symptoms could be shown for interval treatment.

Conclusion

Inpatient interval treatment for adolescents with conduct disorder is an innovative and effective concept, when outpatient treatment has reached its limits.     

Mentalisierungsdefizite bei stationären Patienten

Background

Fonagy (2009) considers the improvement of mentalization, understood as an element of structural change, as a global goal of psychotherapeutic treatment. Yet until now there is little knowledge about the mentalizing skills in clinical populations.

Material and methods

We examined the mentalizing skills in 201 patients on admission for complex psychotherapeutic inpatient treatment with the “Reading the mind in the eyes”-Test (RMET). We explored if there are diagnosis-related differences in the RMET and compared our findings to published data on the RMET in clinical and normal populations.

Results

Compared to normal populations our sample scored significantly lower in the RMET, however, no diagnosis-related differences were found.

Conclusions

Although our data are preliminary, psychotherapeutic inpatient treatment should consider the patients reduced mentalizing skills.     

A Meta-Analytic Review of the Consequences Associated with Work–Family Enrichment

Purpose

This study investigated the relationship between work-to-family enrichment (WFE) and family-to-work enrichment (FWE) with work-related, non work-related, and health-related consequences using meta-analysis.

Design/methodology/approach

We conducted a meta-analytic review of 21 studies (54 correlations) for WFE and 25 studies (57 correlations) for FWE.

Findings

We found that both WFE and FWE were positively related to job satisfaction, affective commitment, and family satisfaction but not turnover intentions. WFE was more strongly related to work-related variables, whereas FWE was more strongly related to non work-related variables. We also found that both WFE and FWE were positively related to physical and mental health. Additionally, relationships appear to depend on moderating variables including the proportion of women in the sample as well as the construct label (e.g., enrichment, facilitation, positive spillover).

Implications

Our work indicates that organizations need to consider ways to not only reduce conflict, but also increase enrichment, which will drive many important outcome variables.

Originality/value

This is the first meta-analysis on the positive side of the work–family interface.     

Elternschaft, Krebs und Kindersorgen

Background

The diagnosis of parental cancer may destabilize the whole family, parents and children as well. The Hamburg children of somatically ill parents (COSIP) intervention supports parental skills and adaptation of children to the situation. There is currently no evidence for criteria to determine which family members should be involved in the COSIP intervention, predominantly the parents (parent setting), the children (child setting) or both (family setting).

Aim of the study

Data from a multicentre study were analyzed with respect to the predominant intervention settings, the correlation between setting and aims of intervention as well as variables that predict the involvement of children in the intervention.

Material and methods

A total of 203 documented cases were analyzed. Different variables that had been documented by the therapists were included in a regression analysis model in order to identify predictive variables.

Results

In 142 cases the intervention was carried out in a specific intervention setting. In 57?% of the cases children were involved (32?% family setting and 25?% child setting). A systematic relationship between the reported intervention aims and the intervention setting was not detected. The most powerful predictor was the existence of emotional problems of children as reported by the child itself.

Conclusions

Decision-making on intervention settings should therefore take the assessment of emotional symptoms of children by the means of age-appropriate self-reporting tools into consideration. Further investigations are needed to reveal variables concerning needs, motivation and capabilities of the family members as well as institutional conditions.     

Nachsorge nach station?rer Psychotherapie f��r Essst?rungen

Background

Despite high relapse rates there is a lack of feasible, effective and efficient interventions to provide aftercare support to patients who complete treatment for an eating disorder. A program based on the short message service (SMS) and text messaging has been developed in order to provide such additional support to patients who undergo inpatient treatment for an eating disorder.

Materials and methods

A total of 165 patients with bulimia nervosa or an eating disorder not otherwise specified were randomly assigned either to the intervention group (n?=?82) with access to the text messaging intervention for 4 months following discharge from hospital or to the control group (n?=?83). The efficacy of the intervention was determined via the three eating disorder related subscales of the Eating Disorder Inventory (EDI-2) at 4 and 8 months follow-up and via the frequency of self-reported binge eating and compensatory behaviors (vomiting and abuse of laxatives) in the Short Evaluation of Eating Disorders (SEED) at 8 months follow-up.

Results

Participants in the intervention group reported significantly lower impairment on the EDI scales drive for thinness and body dissatisfaction both at 4 and 8 months follow-up. They also reported significantly fewer episodes of binge eating and vomiting. No differences were found for the EDI subscale bulimia and for the frequency of the use of laxatives.

Conclusion

The intervention based on text messaging proved efficacious in the aftercare treatment of patients with eating disorders. Chances and limitations concerning its use in the clinical routine as part of a stepped care model are discussed.     

Psychopathy as Predictor and Moderator of Multisystemic Therapy Outcomes among Adolescents Treated for Antisocial Behavior

Objective

The aim of the present study was to determine whether psychopathic traits act as a predictor and/or moderator of the effectiveness of Multisystemic Therapy (MST).

Method

The sample included N?=?256 adolescents (188 boys and 68 girls) referred for conduct problems, randomized to MST or Treatment As Usual (TAU). The mean age was 16 years (SD?=?1.31). Assessments were carried out before and immediately after treatment (6 months later). Three psychopathic traits (callous/unemotional traits, narcissism, and impulsiveness) were assessed with parent reports. Adolescents and parents were informants on externalizing problems.

Results

MST was more effective than TAU in decreasing externalizing problems for the “lower callous/unemotional” and “lower narcissism” group, but not for the “high callous/unemotional” and “high narcissism” group (moderators). Impulsiveness was found to predict more post-treatment externalizing problems rated by adolescents (predictor), but not more post-treatment externalizing problems rated by parents.

Conclusions

These findings point out the clinical relevance of adequately assessing psychopathic traits in adolescents referred for treatment of antisocial behaviour, and identifying those adolescents who show high levels of these traits. It is important to tailor MST specifically to meet the needs of juveniles with high levels of callous/unemotional traits and high levels of narcissism to obtain the same level of effectiveness as with juveniles scoring lower on these traits.     

Erfahrungsorientiertes Lernen in der Psychotherapie

Background

Based on principles of experiential learning, psychophysical exposure (PPE) on a tightrope course offers a promising intervention in the treatment of patients with mental disorders. A PPE program conducted on a hospital tightrope course is presented as an adjunct in inpatient psychotherapy.

Methods

The acceptance and effectiveness of the PPE were evaluated in a prospective controlled naturalistic study. A total of 155 patients, who were exposed at least once during their inpatient therapy, were compared with 92 control patients, who did not participate in the tightrope course. The main outcome criteria were self-reported depressive symptoms, state anxiety, locus of control, self-efficacy, and trait anxiety.

Results

The PPE was highly accepted by the participants. Patients who attended the tightrope courses showed greater improvement in the outcome criteria than patients who received inpatient treatment as usual. Particularly better effects were found on the personality variables.

Conclusions

Psychophysical exposure can successfully and effectively be integrated into a psychosomatic inpatient treatment program. Methodological limitations of the study, especially threats to internal validity, are discussed.     

Internetbasierte Vorbereitung auf eine station?re psychosomatisch-psychotherapeutische Behandlung

Background

Encouraged by promising results of online aftercare programs, this study adapted the concept of internet-based minimal interventions in order to use the time between referral and actual admission to inpatient treatment. The online intervention includes information about the hospital and the treatment and sections which aim to enhance motivation, provide support and allow contact.

Methods

A comprehensive cohort study was conducted with 379 participants in the randomized subcohort. Primary endpoint was the speed of change of the physical, mental and social impairment and of the psychological well-being in the first 2 weeks of inpatient treatment as well as the rates of reliable change 2 weeks after admission.

Results

Both the control and intervention group of the randomized subcohort showed statistically significant improvements in health status. No significant difference in the rate of change was found. The degree of achieved improvement in the physical impairment was equal to the expected intervention effect. A difference in the rates of change was found for the psychological well-being: the intervention group showed 19% more reliable improvements.

Conclusions

The study design and the contents of the intervention were accepted by the patients. The internet-based intervention can help to prepare for treatment and to shorten the settling-in period.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

Individuelle Therapiezielerreichung nach Gruppentherapie „SAVE“

Background

Adolescents with attention deficit hyperactivity disorder (ADHD) are severely impaired in routine daily activities in the same way as adults. Therapy programs focus on improving everyday behavior. Goal attainment scaling (GAS) has already proven to be a suitable instrument for assessing treatment success with adult ADHD patients.

Material and methods

Goal attainment scaling was used in addition to standardized self-evaluation of core symptoms of ADHD in 49 adolescents aged 12-18 years old with a mean age of 14.14 years (standard deviation SD±1.59 years) with ADHD to operationalize treatment success of the cognitive behavior group therapy program SAVE. Behavior-oriented aims and criteria for target achievement were set. To examine treatment success changes were assessed at different time points (10 weeks before treatment, process evaluation during treatment and after treatment).

Results

The adolescents in this study were able to define relevant goals together with the therapists. They focused on goals concerning organization of everyday life, attention, distraction and power of endurance. Goals were reached from the beginning of the study to post-evaluation, even before SAVE started, with great effects (d?=?1.85). Adolescents evaluated changes in symptoms during the course of the SAVE program in general (d?=?0.47) and attention deficits (d?=?0.45) as having significant effects. The reduction in symptoms (attention) was only moderately correlated with the target achievement.

Conclusion

The GAS method has been proven to be a practical instrument to assess treatment success for adolescents with ADHD. Further studies in a controlled design should focus on assessment of the influence of GAS as an intervention method.     

Disaggregating Job Satisfaction: Effects of Perceived Demands,Control, and Support

Purpose

Our purpose was to inductively examine how employees’ perceptions of stressor and resource work characteristics relate to nine distinct facets of job satisfaction, in accordance with the demand–control (–support) [JDC(S)] theory. Job satisfaction is a multidimensional construct composed of various facets that differ greatly from one other. However, most stress studies have examined job satisfaction at the global level. This may be problematic for managers looking to redesign the workplace to increase employee job satisfaction based on established recommendations from previous research.

Design/Methodology/Approach

Data were obtained from employees of a public sector human services organization that provides services to protect children from neglect and other forms of abuse (n = 343). A series of t tests for dependent correlations determined facet-level differences in satisfaction with demand and resource work characteristics.

Findings

We found different patterns of correlations across facets for all seven demand, control, and support workplace characteristics.

Implications

Those re-balancing types of demands, control, and support for workplace redesign should not presume consistent effects on all aspects of satisfaction with work. By doing so, expected positive outcomes may fail to materialize, perhaps to the detriment of workplace redesign as a whole in the minds of management. A more detailed approach to workplace redesign is recommended.

Originality/Value

This is the first study which adopts the JDC(S) framework to examine job satisfaction at the facet level. Our findings shed new light on how workplace characteristics relate to different aspects of satisfaction.     

Domain Satisfaction as a Mediator of the Relationship Between Work–Family Spillover and Subjective Well-Being: A Longitudinal Study

Purpose

Despite greater recognition that public and workplace policies are needed to facilitate work–family integration, scarce evidence exists on whether and how work–family spillover relates to future subjective well-being (SWB). Guided by conservation of resources theory and bottom-up theories of SWB (i.e., domain-specific satisfaction serves as a source of overall SWB), we investigated the relationship between work–family spillover and future life satisfaction and the potential mechanisms of the relationship (job and marital satisfaction). The relative contribution of positive and negative work–family spillover to SWB was also examined.

Design/Methodology/Approach

Lagged analyses were conducted on self-reported data from a representative U.S. sample over a 9-year interval (N = 2588).

Findings

Individuals who experienced negative work-to-family spillover were less satisfied with their life at a 9-year follow-up, whereas those who experienced positive family-to-work spillover reported higher life satisfaction at the follow-up. These prospective associations remained significant when considering other established predictors of life satisfaction (baseline life satisfaction, health, gender, income, and personality) and were mediated by job satisfaction and marital satisfaction.

Implications

This study provides empirical evidence for ongoing advocacy for working families, suggesting that policies that facilitate positive family-to-work spillover and minimize negative work-to-family spillover should be regarded as essential to enhance SWB of individuals in our society in the long run.

Originality/Value

This study expands our understanding of the causal relationship between work–family spillover and life satisfaction by considering both positive and negative spillover and demonstrating the mechanisms by which work–family spillover relates to future life satisfaction, even beyond personality, health, and income.

     

Bindungsrelevante Situationen in der Psychotherapie

Background

The therapeutic relationship is a central factor for psychotherapy, which may be at least partially explained by attachment theory. However, research concerning the conditions under which attachment-related needs are activated in treatment followed by possibly dysfunctional coping strategies is rare.

Patients and methods

Semi-structured interviews on attachment-related situations in psychotherapies were conducted with 36 inpatients and then rated with regard to content.

Results

Triggers for attachment-related needs in therapies were interpersonal conflict and loss, beginning and end of therapy, symptom burden, specific interventions, addressing the therapeutic relationship and change of setting from outpatient to inpatient treatment. This was related to themes of desire for help and support, experience of rejection, self-disclosure and desire for understanding.

Conclusions

The attachment system is activated in therapies similar to other interpersonal situations. The results may help to become more sensitive to attachment-related situations and needs.     

Kreuzvalidierung der Kurzform des Kindheitsfragebogens

Objectives

Existing questionnaires about parent-child relationships usually assess love and control only. The childhood questionnaire (CQ) offers a more differentiating alternative.

Methods

In a sample of approximately 1,400 patients and more than 500 controls the CQ was reduced from 22 to 11 scales and the number of items of each scale was shortened to 5.

Results

The shortened scales of the CQ also showed good reliability and item characteristics, as well as plausible intercorrelations.

Conclusion

By the use of 66 out of the former 128 items, the shortened version of the CQ assesses three further important dimensions in the parent-child relationship of adults towards their parents in childhood besides love and control: punishment, ambition and role reversal. Beside this, parental separation, divorce and job status as well as various parameters of the socio-economic status (e.g. educational, occupational and financial) of the parents can be assessed.     

The Impact of Organizational Factors on Psychological Needs and Their Relations with Well-Being

Purpose

The purpose of the present research was to examine the relationships between perceived organizational support, perceptions of supervisor’s interpersonal style, psychological need satisfaction and need thwarting, and hedonic and eudaemonic well-being.

Design/Methodology/Approach

In Study 1 (n?=?468), we tested a model in which workers’ perceived organizational support and their perceptions of their supervisor autonomy support independently predicted satisfaction of the workers’ needs for autonomy, competence, and relatedness, which in turn predicted aspects of hedonic and eudaemonic well-being. In Study 2 (n?=?650), workers’ perceptions of supervisor controlling behaviors and need thwarting were added to the hypothesized model tested in Study 1. Scales of work satisfaction and positive affect were used to assess hedonic well-being, and a scale of psychological well-being was used to assess eudaemonic well-being.

Findings

Perceived organizational support and supervisors’ interpersonal style related to basic need satisfaction (Studies 1 and 2) and need thwarting (Study 2). In turn, need satisfaction predicted higher levels of hedonic and eudaemonic well-being, while need thwarting was negatively associated with hedonic and eudaemonic well-being.

Implications

The present results underscore the importance of understanding the mechanisms through which organizations and managers related to workers’ hedonic and eudaemonic well-being.

Originality/Value

This is the first research to provide evidence for the mediating role of need satisfaction and need thwarting in the relationships between perceived organizational support, perceptions of supervisor’s interpersonal style, and hedonic and eudaemonic well-being. The present results were obtained in two samples of employees from various small to large companies.